Presentation
Difficult delivery. Increased work of breathing.
Patient Data
NG tube in an appropriate position.
The lungs are clear.
Abnormality of the left shoulder with increased space between the glenoid and humeral metaphysis. Appearances concerning for a dislocation or transphyseal humeral fracture.
The dedicated view of the clavicle and left arm confirms the suspected increased distance at the shoulder but no evidence of any other fracture or dislocation.
A transphyseal humeral fracture was confirmed by the orthopods on palpation during closed reduction. There was no shoulder dislocation.
This could have been confirmed with ultrasound too.
Follow-up radiograph with the arm be nursed in a bandage. There is early new bone formation around the healing fracture at the epiphyseal/metaphyseal junction.
Case Discussion
Transphyseal fractures are exceptionally rare and can cause growth disturbance.. In this case, the left arm symptoms were not described on the request for the initial x-ray.
Where there are clinical features of a clavicle fracture, but the clavicle appears normal, look at the shoulder joint and compare it to the other side.
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