Ultrasonography applied in guiding the reduction and assessing the healing of distal humeral epiphysis fracture-separation in a neonate—A case report

Fracture-separation of the distal humeral epiphysis is a relatively rare injury in neonates and might occur as a complication of difficult deliveries. Fracture in skeletally immature children is often difficult to assess on plain radiographs, and more so in neonates or in the meta- and epiphysis areas where secondary ossification centers are absent. We described the case of a neonate with a type 1 Salter–Harris fracture of the distal humerus following uncomplicated labor of vaginal delivery without instrument use. The baby presented with gross elbow swelling that was accurately diagnosed with ultrasonography as a posterolateral displacement of the epiphysis which was not apparent on plain radiography and was further confirmed by MRI and intraoperative findings. The fractured distal humerus was reduced by percutaneous reduction after several attempts at close reduction. Serial follow-up ultrasonographies revealed good reduction and healing. In a final examination at age 4 years, the child had no residual deformity and normal range of motion.