Pediatric Distal Humerus Transphyseal Fractures

Abstract

Distal humerus transphyseal fracture, also referred to as transphyseal separation , is a physeal periarticular elbow injury found most commonly in young children between birth and 3 years of age. Transphyseal fracture of the newborn is rare, occurring in only one of a series of 105,119 live births. It is more common as a result of falls in infants and toddlers. The diagnosis continues to remain difficult due to the cartilaginous nature of the distal humeral epiphysis in this age group, which is not well visualized on plain radiographs. Numerous case series and case reports have described common misdiagnoses including supracondylar humerus fractures, elbow dislocations, lateral condyle fractures, infection, brachial plexus injury, and normal appearance. Classically, the distal fragment is displaced posteromedially, although posterolateral and anterolateral displacement have also been described. Radiographs of the arm will frequently reveal that the axis of the forearm is no longer in line with the humerus. Ultrasound, MRI, and arthrography have also been used to aid in the diagnosis. Historically, treatment has included closed reduction and casting, skin traction, open reduction and internal fixation (ORIF), and closed reduction and percutaneous pinning (CRPP). The most common complications include cubitus varus and loss of flexion and extension; however, avascular necrosis has also been reported.