OrthoNet

Distal Humerus
Distal Humeral Physeal Injuries

Remember to think about child abuse when you see this injury!

DeLee Classification:
A - prior to ossification of the capitellum (0-7 months)
B - capitellum ossified (7months to 3 years)
C - capitellum well ossified and you can see a Thurston Holland fragment

The confusion is distinguishing this injury from lateral condyle fracture, elbow dislocation, or radial head dislocation.
For starters - get an X-ray of the normal limb.

1. If the capitellum has not ossified yet - consider getting an arthrogram or MRI if still wondering.
- look at the relationship between the radius/ulna and humerus - if the radius/ulna are out laterally, it is more likely to be an elbow dislocation; if it is out medially, it is more likely to be a distal humeral physeal injury
- also note: elbow dislocation in this age group is exceedingly RARE.

2. If the capitellum has ossified - look at the relationship between the radial head and the capitellum, and look at the relationship between the capitellum and the distal humerus.

If the relationship is intact - think distal humeral physeal injury or supracondylar fracture; look at where the capitellum is in relation to the distal humerus. In a distal humeral physeal injury the capitellum is displaced medially, and you can confirm this by comparing it to the normal elbow X-ray. It is off posteriorly in the supracondylars

If the relationship between the capitellum and proximal radius is NOT intact - think elbow dislocation, lateral process fracture, or radial head dislocation.

Treatment
- rule out child abuse
-decide if it needs to be reduced - gentle traction and correct the medial displacement and malrotation, then flex to 90 and pronate - put into a splint.

- watch out for cubitus varus - it can develop with this injury.