Birth Injuries to the Epiphyseal Cartilage

Abstract

A birth injury in the vicinity of a joint might lead to a fracture through the epiphyseal cartilage. The criteria for diagnosing such a fracture at radiography are considered and the continued remodelling of the bone demonstrated. The history of 2 cases with late diagnosis and serious long-term sequelae are described, in order to emphasize the necessity of early radiography.

Definitive diagnosis of fracture-separation of the distal humeral epiphysis in neonates by ultrasonography

“…However, this relationship cannot be ascertained radiographically in neonates because the epiphysis is still cartilaginous. Thus, radiography is inconclusive in distinguishing between dislocation and fracture-separation [6,7,14,15]. Elbow arthrography, which delineates the cartilaginous epiphysis, may demonstrate the injury, but the investigation is invasive and there is a risk of infection [10,12,14,15].…”

“…Only 20 cases of fracture-separation of the distal humeral epiphysis in newborns have been described since 1963 [1,[4][5][6][7][8][9][10][11][12][13][14]. The probable reason for this paucity of reports is that the injury is often misdiagnosed clinically and radiologically and is therefore underreported [3,7,13,14]. The ossification center of the capitellum appears only at 3-9 months of age; before this, its alignment with the head of the radius cannot be ascertained radiographically [3,6,7,10,14,15].…”

“…The probable reason for this paucity of reports is that the injury is often misdiagnosed clinically and radiologically and is therefore underreported [3,7,13,14]. The ossification center of the capitellum appears only at 3-9 months of age; before this, its alignment with the head of the radius cannot be ascertained radiographically [3,6,7,10,14,15]. As a result, radiographic examination in neonates cannot distinguish between distal humeral epiphyseal separation and elbow dislocation [2,8,[14][15][16][17][18] (Fig.…”

Neonatal Distal Femoral Physeal Fracture Requiring Closed Reduction and Pinning

“…If the fracture extends through part of the metaphysis, a tiny bone fragment separates and may appear on the standard radiograph. 1 Recent utilization of ultrasonography, [3][4][5] or computed tomography 2 and magnetic resonance imaging (MRI) 2,5 have offered promise in facilitating a more timely diagnosis. Consideration of specific high-risk perinatal factors may also lead to earlier suspicion of this lesion.…”

Sonography of slipped humeral epiphysis due to birth injury

“…Slipped epiphysis due to birth injury represents a rare condition with diagnostic problems [1,2]. With no epiphyseal ossification center and most commonly a fracture type I corresponding to Salter and Harris [3] the radiological signs of a slipped epiphysis namely enlarged joint space, displacement of the nidus, distancing of the metaphysis and metaphyseal bony fragmentations can be missing.…”