Objectives: Transphyseal separation of the distal humeral epiphysis in newborn can mimic elbow dislocation & due to the absence of ossification of the epiphysis, cannot be diagnosed radiographically. We reviewed 5cases in which a fracture-separation of the distal humeral epiphysis was diagnosed with the help of sonography. The purpose of this presentation is to emphasize the utility of ultrasound as a tool for the evaluation of the nonossified epiphysis in the newborn elbow. Methods: All babies were seen within 15 days of birth. Two babies were referred by pediatrician. In three babies reduced movements at affected elbow were observed by mother. In two cases there was history of difficult labour whereas in three cases no such history could be elicited. In three cases plain radiograph was done. Ultrasound was done in all cases using phillips HD11 ultrasound machine with linear L12-3 MHz frequency transducer. Scanning was done longitudinally along the length of humerus along the lateral side & from posterior aspect. Results: Plain radiograph demonstrated posteromedial displacement of the distal fragment in 3 cases and possibility of dislocation was reported. However, traumatic dislocation of elbow at birth is extremely rare. Ultrasound clearly demonstrated the cartilaginous epiphysis of distal humerus in relationship to forearm. The epiphysis of distal humerus is displaced medially and posteriorly. The distal humerus epiphysis and proximal epiphysis of forearm are visualized as one unit together in relation to the distal shaft of humerus. This is in contrast to the elbow dislocation where distal shaft of humerus and epiphysis together separate from proximal forearm epiphysis and shaft. All babies were managed conservatively & no varus deformity was seen at the end of 6 months to one year. Conclusions: Ultrasound establishes correct diagnosis and can record the direction & magnitude of displacement of epiphysis. It also allows continuous monitoring during healing phase. In conclusion, ultrasound as a diagnostic tool allows early and accurate identification of this entity, and we suggest using it as first modality of choice prior to other modalities such as radiographs or MRI (requires general anesthesia).
Joshi, A. N. (2015). 2084769 Usefulness of Ultrasound in Diagnosis of Transphyseal Separation of Distal Humeral Epiphysis in Neonates. Ultrasound in Medicine & Biology, 41(4), S91. https://doi.org/10.1016/j.ultrasmedbio.2014.12.364