Title: Fracture Separation of the Distal Humeral Physis Sustained at Delivery
1Fracture 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
2Fracture Distal Humeral Physis
- Due To Rotatory Forces
- Seen From Newborn To 6 Years
- Peak 2 Years
- Usually Seen After Difficult Deliveries Or Child
Abuse
3Fracture 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
4Fracture Distal Humeral Physis
- All Had X-rays
- 1 Patient Had Arthrogram
- 2 Patients Had Ultrasound
- 2 Patients Had MRI
MRI
US
X-ray
5Fracture 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
6Fracture 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
7 8 Year Follow Up
2006
1998
2006
2006
1998
8Fracture 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
9Fracture Distal Humeral Physis
- Literature Has Diverse Recommendations for
Treatment - Closed Reduction
- Close Reduction And Pinning
- Open Reduction And Pinning
10Fracture 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