Distal Humerus Physeal Separation in Young Children: A Frequently Missed Diagnosis

Abstract

A 2-year-old child fell and landed on the left hand. Post-trauma, he developed swelling over his left elbow and refused to move the left elbow. He was brought to the emergency department and initially diagnosed with left elbow dislocation. A careful study of the plain radiograph of the left elbow showed left distal humerus physeal separation. A gentle closed manipulative reduction was attempted under sedation but failed to achieve good alignment. The child was put under general anaesthesia, where an elbow arthrogram was performed and closed manipulative and percutaneous pinning was done. The child regained full elbow range of motion at 4 months post-injury. At 1 year follow-up, there was no deformity noted. Distal humerus physeal separation is a relatively uncommon presentation and frequently missed diagnosis due to the cartilaginous nature of the distal humerus. It may result in growth disturbance, deformity, and functional limitations.