Birth injuries to growth plates: A sheep in wolves' clothing

Abstract

Growth plate injuries (Salter-Harris type 1 or physeal fractures) of the long bones in the newborn are easily misdiagnosed as joint fractures with dislocations due to their nonossified epiphyses on plain radiographs. Diagnosis with musculoskeletal ultrasound (US) is advantageous due to its ability to visualize the nonossified epiphysis. We present two cases of humeral growth plate fractures in newborns, one at the shoulder (proximal humerus) and the other at the elbow (distal humerus). These cases emphasize the importance of quick and noninvasive diagnosis with US to avoid unnecessary intervention. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:511-514, 2017.

Proximal humerus fracture in a newborn-like a thief in the night

“…4 Prolonged or difficult labor, deliveries complicated by shoulder dystocia, breech presentation and transverse lie are risk factors for birth-associated injuries. 5 Neonatal proximal humeral epiphysis fracture separations are usually presented with swelling, tenderness, decreased active motion and irritability with passive motion. There might be a muffled crepitus associated.…”

“…There might be a muffled crepitus associated. 1,2,5 Due to the non-ossification of the epiphysis, injuries might be missed or misdiagnosed. Differential diagnosis includes clavicular fracture, shoulder dislocation, humeral shaft fracture, brachial plexus injury, septic arthritis or osteomyelitis, although the last two are uncommon in neonates.…”

“…3,4 The radiographic evaluation may be limited due to the nonossification of the epiphyses and the only radiographic finding may be abnormal alignment of the diaphysis and the glenoid, thus appearing a dislocation. 5 Diagnosis might be made with the help of ultrasound or MRI.…”

Neonatal Transphyseal Separation of the Distal Humeral Epiphysis: Early Diagnosis and Immediate Treatment with Radiographic Evaluation

“…There is the possible danger of permanent damage of the distal physeal growth plate in cases of forceful reductions in late-diagnosed injuries. Open reduction is hardly justified in late cases, as reported by Gigante et al in their series [ 2 , 7 ].…”

“…Since the capitellum epiphysis is not ossified in a neonate, this complicates the diagnosis. Ultrasound examination is helpful and magnetic resonance imaging (MRI) examination is often required to establish the correct diagnosis [ 6 , 7 , 8 ]. The lesion affects the growth plate of the distal part of the humerus and adequate reduction is important for the normal development of the elbow in later life [ 2 ].…”