Ultraschall in Med 2012; 33(7): E361-E363
DOI: 10.1055/s-0031-1281660
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Slipped Distal Humerus Epiphysis in Tiny Infants Easily Detected and Followed-Up by Ultrasound

Distale Humerusepiphysenlösung bei Säuglingen. Diagnose mittels UltraschallA. Fette, J. Mayr
Further Information

Publication History

received: 22.3.2011

accepted: 19.7.2011

Publication Date:
24 January 2012 (eFirst)

Introduction

Impaired function of the upper extremity in newborns is either caused by congenital dysplasia or obstetrical trauma. The latter frequently results in fractures of the clavicle and plexus palsy or more rarely in a dislocated elbow joint or a slipped humerus epiphysis. In tiny infants both could be non-incidental as well. Due to the general absence of ossific nuclei in infants of this age and the rarity and unimpressive clinical appearance of such lesions, they are often missed or misinterpreted in the first instance.

REFERENCES

  • 1 Al-Aubaidi Z, Nielsen K D. Traumatic distal humerus epiphysiolysis in a newborn child.  Ugeskr Laeger. 2010;  172 2231-2232
  • 2 Akbarnia B A, Silberstein M J, Rende R J et al. Arthrography in the diagnosis of fractures of the distal end of the humerus in infants.  J Bone Joint Surg Am. 1986;  68 599-602
  • 3 Barett W P, Almquist E A, Staheli L T. Fracture separation of the distal humerus physis in the newborn.  J Pediatr Orthop. 1984;  4 617-619
  • 4 Downs D M, Wirth C R. Fracture of the distal humeral chondroepiphysis in the neonate. A case report.  Clin Orthop. 1982;  169 155-158
  • 5 Holda M E, Manoli A, LaMont R I. Epiphyseal separation of the distal end of the humerus with medial displacement.  J Bone Joint Surg. 1980;  62 A 52-57
  • 6 DeLee J C, Wikins K E, Rogers L F et al. Fracture separation of the distal humerus epiphysis.  J Bone Joint Surg. 1980;  62 A 46-51
  • 7 Rose R E, Dixon R, Bullock R. Chondro-epiphyseal separation of the distal humerus.  West Indian Med J. 2002;  51 268-271
  • 8 Dias J J, Lamont A C, Jones J M. Ultrasonic diagnosis of neonatal separation of the distal humerus epiphysis.  J Bone Joint Surg Br. 1988;  70 825-828
  • 9 Pistor G, Graffstädt H. Sonographische Beurteilung von supracondylären Humerusfrakturen.  Ultraschall in Med. 2003;  24 331-339
  • 10 Bar-On E, Howard C B, Porat S. The use of ultrasound in the diagnosis of atypical pathology in the unossified skeleton.  J Pediatr Orthop. 1995;  15 817-820
  • 11 Tudisco C, Mancini F, De Maio F et al. Fracture-separation of the distal humeral epiphysis. Long-term follow-up of five cases.  Injury. 2006;  37 843-848
  • 12 Mostbeck G. High-Resolution Ultrasound of Surface Bones.  Ultraschall in Med. 2008;  29 265-266
  • 13 Ern-Yoong Wong C, Su-Yin Ang A, Ng K C. Ultrasound as an aid for reduction of paediatric forearm fractures.  Int J Emerg Med. 2008;  1 267-271
  • 14 Konermann W, Gruber G. Sonographic standard sections at the upper extremity: elbow joint.  Ultraschall in Med. 1998;  19 130-138
  • 15 Moritz J D, Berthold L D, Soenksen S F et al. Ultrasound in diagnosis of fracture in children: unnecessary harassment or useful addition to x-ray ?.  Ultraschall in Med. 2008;  29 267-274
  • 16 Grechenig W, Mayr J, Fellinger M et al. Sonoanatomie und -pathologie des Ellenbogengelenkes beim Kind und beim Erwachsenen.  Radiologe. 1998;  38 378-389
  • 17 Riebel T, Nasir R. Ultrasound of extremity lesions caused by birth trauma.  Ultraschall in Med. 1995;  16 196-199
  • 18 Raupp P, Haas D, Lovasz G. Epiphyseal separation of the distal humerus.  J Perinat Med. 2002;  30 528-530
  • 19 Ziv N, Litwin A, Katz K et al. Definitive diagnosis of fracture-separation of the distal humeral epiphysis in neonates by ultrasonography.  Pediatr Radiol. 1996;  26 493-496
  • 20 Princic J, Tonin M, Ales A. Birth trauma as the cause of fracture of the distal epiphysis of the humerus. A case report.  Unfallchirurg. 1995;  98 487-488
  • 21 Cummings R J, Jones E T, Reed F E et al. Infantile dislocation of the elbow complicating obstetric palsy.  J Ped Orthop. 1996;  16 589
  • 22 Nimkin K, Kleinman P K, Teeger S et al. Distal humeral epiphyseal injuries in child abuse: MR imaging and ultrasonography findings.  Pediatr Radiol. 1995;  25 562-565
  • 23 Hansen M, Weltzien A, Blum J et al. Complete distal humeral epiphyseal separation indicating a battered child syndrome: a case report.  Arch Orthop Trauma Surg. 2008;  128 967-972 Epub 2007 Oct 27
  • 24 Söyüncü Y, Çevikol C, Söyüncü S et al. Detection and treatment of traumatic separation of the distal humeral epiphysis in a neonate: a case report.  Tuerkish Journal of Trauma & Emergency Surgery Ulus Travma Acil Cerrahi Derg. 2009;  15 99-102
  • 25 Schmit P, Hautefort P, Raison-Boulley A M. Ultrasonographic diagnosis of an epiphyseal detachment of the upper end of the humerus due to birth injury.  J Radiol. 1999;  80 466-468
  • 26 Sawant M R, Narayanan S, O’Neill K et al. Distal humeral epiphysis fracture separation in neonates-diagnosis using MRI scan.  Injury. 2002;  33 179-181
  • 27 Zieger M, Dörr U, Schulz R D. Sonography of slipped humeral epiphysis due to birth injury.  Pediatr Radiol. 1987;  17 425-426
  • 28 Blab E, Geissler W, Rokitansky A. Sonographic management of infantile clavicular fractures.  Pediatr Surg Int. 1999;  15 251-254
  • 29 Kayser R, Mahlfeld K, Heyde C et al. Ultrasonographic imaging of fractures of the clavicle in newborn infants.  J Bone Joint Surg Br. 2003;  85 115-116
  • 30 Gilbert S R, Conklin M J. Presentation of distal humerus physeal separation.  Pediatr Emerg Care. 2007;  23 816-819

Prof. Andreas Fette

Medical School, University of Pecs

Hungary

Drosselstr. 4 Weissach im Tal

Germany

Phone:  ++ 49/71 91/5 33 06

Fax:  ++ 49/71 91/49 39 47

Email: andreas.fette@gmx.de