Fracture Separation of the Distal Humeral Physis Sustained at Delivery

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Fracture Separation of the Distal Humeral Physis
Sustained at Delivery

• Stig Jacobsen
• Göran Hansson
• Johan Nathorst-Westfelt

Marshfield Clinic, Marshfield WI USA Queen Silvia
Childrens Hospital, Gothenburg, Sweden
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Fracture Distal Humeral Physis

• Due To Rotatory Forces
• Seen From Newborn To 6 Years
• Peak 2 Years
• Usually Seen After Difficult Deliveries Or Child
  Abuse

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Fracture Distal Humeral Physis

• Material
• 6 Newborns Presented With Fractures
• 5/6 Had Difficult Delivery
• In 3/6 Children The Diagnosis Was Missed At Birth
• All Had Significant Displacement

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Fracture Distal Humeral Physis

• All Had X-rays
• 1 Patient Had Arthrogram
• 2 Patients Had Ultrasound
• 2 Patients Had MRI

MRI
US
X-ray
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Fracture Distal Humeral Physis

• Treatment
• 3 Patients Presented Late And Were Casted In
  Flexion And Pronation
• 1 Patient Traction Followed By Casting
• 2 Patients Had Closed Reduction And Casting

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Fracture Distal Humeral Physis

• Follow up 16-78 Months
• 5/6 Had Normal Carrying Angle
• 1/6 Had A Slight Decrease In Carrying Angle
• All Had Normal ROM

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8 Year Follow Up
2006
1998
2006
2006
1998
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Fracture Distal Humeral Physis

• Literature Review
• 27 Patients With Fractures At Birth 1 Had Varus
  Deformity At Follow Up
• 106 Patients With Fractures Sustained gt 6 Months
  Of Age 38 Had Varus At Follow-up

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Fracture Distal Humeral Physis

• Literature Has Diverse Recommendations for
  Treatment
• Closed Reduction
• Close Reduction And Pinning
• Open Reduction And Pinning

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Fracture Distal Humeral Physis

• Conclusions
• Displaced Fractures At Delivery Do Well
• No Significant Varus At Follow-up
• Closed Reduction And Casting Is Recommended For
  Treatment
• Diagnosis Commonly First Established After A
  Couple Of Days