Distal humerus physeal separation

Distal humerus physeal separation is seen in children under 3 years and is often associated with non-accidental injury ¹.

Clinical presentation

The child will usually present with a reduced range of motion with swelling and ecchymosis around the joint ².

Pathology

The injury can occur during vaginal delivery or Cesarean section with excessive traction or shear force. Rotational and twisting forces can also cause this separation, often associated with non-accidental injuries ¹.

Radiographic features

Plain radiograph

Radiographic diagnosis can be difficult if the capitellar ossification center is not present. If present, the ossification center should align with the radial shaft. X-ray findings would also note posteromedial displacement of the ulna and radius relative to the distal humerus.

Ultrasound

Can be used for diagnosis by looking for separation of epiphysis from metaphysis ³.

Treatment and prognosis

Most fractures are displaced and managed with closed reduction and pinning. For delayed presentations non-operative treatment can be considered and treat the residual deformity at a later stage ².