Ultrasonography of Separation of the Distal Humeral Epiphysis in an Infant : A Case Report

Abstract

Traumatic separation of the distal humeral epiphysis is rare injury in infant. We report a case in which ultrasonographic examination provided adequate diagnosis of the injury and state of the reduction. A 6-month-old boy was injured with rotary shear forces. Plain radiographs revealed that the proximal radius and ulna maintained an anatomic relationship to each other but were displaced posteriorly and medially in relation to the distal humerus. Ultrasonographic examination of both the injured elbow and the opposite uninjured elbow was carried out. The scans confirmed the epiphyseal separation and its displacement in the longitudinally along the length of the elbow from the lateral, anterior and medial side. We diagnosed his condition as separation of the distal humeral epiphysis (Salter-Harris type 1). Open reduction by using the lateral approach and the fixation with 3 percutaneous pins laterally placed was performed. Intraoperative findings were the same as ultrasonographic examination. And the state of the reduction and fixation were compared with the opposite uninjured elbow ultrasonographically. The pins were removed in 4 weeks and the cast removed 6 weeks.
Ultrasonographic examination is non-invasive and can easily be performed on an infant at outpatient. It can provide adequate diagnosis of the cartilaginous epiphysis.