Ortho Oracle - orthopaedic operative atlas
Home » Joints » Elbow » Distal Humeral Physeal Separation

Distal Humeral Physeal Separation

- See: Pediatric Elbow Injuries

- Discussion:
    - most frx involving total distal humeral physis occur before age 6 or 7;
    - in an infant less than one year of age, whose elbow is swollen 2nd to trauma or suspected trauma, frx involving the entire distal humeral
          physis should always be suspected;

- Radiographs:
    - proximal radius and ulna maintain anatomical relationship to each other but are displaced posterior and medially in relation to distal humerus;
    - distinguish between DHPS and elbow dislocation:
          - in elbow dislocation, proximal radius & ulna usually are displaced posterolaterally & relationship between proximal radius & lateral condyle epiphysis is disrupted;
          - in physeal separation displacement is usually posterior & medial;
          - arthrogram is helpful in cases in which ossification centers are not present;

- Management:
    - infants: closed reduction and casting (elbow flexed);
    - children: closed reduction and percutaneous pinning (lateral pins);
          - arthrogram may help confirm adequacy of the reduction;
    - delayed diagnosis: after 5-6 days manipulation may increase the risk of AVN

Fracture separation of the distal humeral physis in the newborn.

Radiographic diagnosis of fracture-separation of the entire distal humeral epiphysis.

Fracture-separation of the distal humeral epiphysis.

Physeal fractures of the distal humerus: avoiding the pitfalls.  

Epiphyseal separation of the distal end of the humerus with medial displacement.

Fracture-separation of the distal humeral epiphysis in young children.

Fracture separation of the distal humeral epiphysis.  

Fracture separation of the distal humeral epiphysis in children younger than three years old.

Distal humeral epiphyseal separation.