Distal humerus physeal separation
Citation, DOI, disclosures and article data
At the time the article was created Sajanakan Sriselvakumar had no financial relationships to ineligible companies to disclose.View Sajanakan Sriselvakumar's current disclosures
At the time the article was last revised Henry Knipe had the following disclosures:
- Radiopaedia Events Pty Ltd, Speaker fees (past)
- Integral Diagnostics, Shareholder (ongoing)
- Micro-X Ltd, Shareholder (ongoing)
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Distal humerus physeal separation is seen in children under 3 years and is often associated with non-accidental injury 1.
The child will usually present with a reduced range of motion with swelling and ecchymosis around the joint 2.
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 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.
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.
- 1. Mathew D, Gangadharan S, Krishnamoorthy V, Shanmughanathan R. Anterior Physeal Separation of Distal Humerus: Report of a Rare Case with Review of Literature. Indian J Orthop. 2021;55(1):208-12. doi:10.1007/s43465-020-00111-9 - Pubmed
- 2. Sferopoulos N. Traumatic Separation of the Distal Humeral Epiphysis. ARC Journal of Orthopedics. 2017;2(1). doi:10.20431/2456-0588.0201004
- 3. Supakul N, Hicks R, Caltoum C, Karmazyn B. Distal Humeral Epiphyseal Separation in Young Children: An Often-Missed Fracture—Radiographic Signs and Ultrasound Confirmatory Diagnosis. AJR Am J Roentgenol. 2015;204(2):W192-8. doi:10.2214/ajr.14.12788 - Pubmed