Distal Humeral Physeal Injuries
Remember to think about child abuse when you see this injury!
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.
– 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.
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