Distal Humerus Physeal Separation - Pediatric

Topic updated on 01/03/16 4:10pm
  • Also called transphyseal distal humerus fracture
  • Epidemiology
    • demographics
      • typically seen in children under the age of 3
  • Associated conditions
    • abuse or battered child syndrome (up to 50%) 
  • Prognosis
    • often missed diagnosis as very difficult to diagnose

  • Radiographs 
    • recommended views
      • AP and lateral of elbow 
      • stress radiographs may be helpful to clarify the diagnosis
    • findings
      • in infant only sign may be posteromedial displacement of the radial and ulnar shafts relative to the distal humerus   
  • Ultrasound, MRI, arthrography
    • may be helpful to clarify the diagnosis
  • Nonoperative
    • posterior long arm splint then long arm casting
      • indications
        • nondisplaced fractures
  • Operative
    • Closed reduction and pinning 
      • indications
        • displaced fractures
  • Cubitus varus
  • Medial condyle AVN


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Qbank (4 Questions)

(OBQ12.120) Which of the following injuries shown in Figures A-E is most commonly the result of child abuse? Topic Review Topic
FIGURES: A   B   C   D   E  

1. Figure A
2. Figure B
3. Figure C
4. Figure D
5. Figure E

(OBQ05.54) A 10-month-old child fell off of the couch and has left elbow pain and swelling. A radiograph is shown in Figure A. All of the following are characteristics of this injury pattern EXCEPT: Topic Review Topic
FIGURES: A          

1. High risk of tardy ulnar nerve palsy
2. Posteromedial displacement
3. High association with child abuse
4. High risk of cubitus varus deformity
5. High risk of subsequent avascular necrosis of the medial condyle

(OBQ05.68) A 7-month-old girl cries when the mother touches her swollen left elbow. Figure A displays a series of radiographs. In Figure A, the images labeled A and B show the painful left elbow, while C and D are of the contralateral, non-injured elbow. What is the most appropriate treatment? Topic Review Topic
FIGURES: A          

1. Open reduction and internal fixation
2. Closed reduction and percutaneous pinning
3. Closed reduction and casting
4. Functional bracing
5. Closed reduction and hinged external fixation

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