Percutaneous fixation of neonatal humeral physeal fracture: A case report and review of the literature

Abstract

BACKGROUND Neonatal distal humeral physeal fractures are rare and difficult to diagnose. Thus, missed diagnoses and delayed healing are possible. Few studies have reported surgical treatment, because a callus may develop at the fracture site 5 d after the fracture, resulting in difficult reduction, and reduction of the limb may cause further physeal injury. Other surgical challenges include the provision of adequate anesthesia and complexity of the operation. However, without appropriate reduction and fixation, a varus elbow deformity may develop. Manual reduction and percutaneous pin fixation are ideal treatment options. CASE SUMMARY A 4-day-old neonate with left elbow pain accompanied by limited movement for 4 d was admitted, and diagnosed with delayed physeal fracture of the distal humerus based on physical examination, ultrasonography, and magnetic resonance imaging. The patient was treated by manual reduction combined with percutaneous pin fixation under arthrography. Postoperatively, the reduction was successful. The upper limbs could have been lifted and the fingers could have been moved freely on the second day after the operation. CONCLUSION The techniques of manual reduction and percutaneous pin fixation, to treat neonatal distal humeral physeal fractures, are safe and reliable.

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

“…Tan et al reported a case of displacement of the epiphysis in the anterior subcutaneous tissue in the elbow, threw the brachialis muscle, like a buttonhole. They also used K wire to stabilize the lesion [ 20 ]. In general, epiphyseal injuries Salter-Harris Type 2, are stable when appropriately reduced and the use of K-wire must be used with caution in the neonatal period.…”