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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 6,
797-802.
doi: 10.1302/0301-620X.91B6.22140 Copyright © 2009 by British Editorial Society of Bone and Joint Surgery Traumatic separation of the distal epiphysis of the humerus sustained at birthS. Jacobsen, MD, Pediatric Orthopaedic Surgeon1; G. Hansson, MD, PhD, Associate Professor2; and J. Nathorst-Westfelt, MD, PhD, Senior Consultant2
1 Department of Orthopaedic Surgery The Marshfield Clinic, 1000 North Oak Avenue, Marshfield, Wisconsin 54449, USA. Correspondence should be sent to Dr S. Jacobsen; e-mail: jacobsen.f.stig{at}marshfieldclinic.org
We reviewed the clinical and radiological results of six patients who had sustained traumatic separation of the distal epiphysis of the humerus at birth. The correct diagnosis was made from plain radiographs and often supplemented with ultrasonography, MRI and arthrography. An orthopaedic surgeon saw two patients within two days of birth, and the other four were seen at between nine and 30 days. The two neonates underwent unsuccessful attempts at closed reduction. In the remaining patients, seen after the age of eight days, no attempt at reduction was made. All six displaced fractures were immobilised in a cast with the elbow at 90° of flexion and the forearm pronated. When seen at a mean of 58 months (16 to 120) after injury, the clinical and radiological results were excellent in five patients, with complete realignment of the injury. In one patient the forearm lay in slightly reduced valgus with the elbow in full extension. Traumatic separation of the distal epiphysis of the humerus may be missed on the maternity wards and not diagnosed until after discharge from hospital. However, even when no attempt is made to reduce the displaced epiphysis, a good clinical result can be expected.
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