Management on Fracture-Separation of Distal Humeral Epiphysis in Children.

Abstract

Objective To analyze the diagnosis and treatment of fracture-separation of distal humeral epiphysis (Salter-Harris epiphyseal injury) in neonates or young children for the purpose of decreasing the misdiagnosis and its complications. Methods From January 2002 to January 2008, 76 cases with fracture-separation of distal humeral epiphysis were analyzed retrospectively. The diagnosis was mainly based on clinical presentations and X-radiology. The closed manipulative reduction and operation were used in this study. The research data were checked by the rank-sum test. Results Fracture-separation of distal humeral epiphysis was diagnosed by X-radiology (n=52), clinical information and operative findings (n=24). The main clinical presentations of fracture-separation of distal humeral epiphysis were arthrocele, pain and limitation of motion. All cases were closed fracture. There were good peripheral circulation and joint motion of forearm or hand without paresthesia of skin, except 3 cases had ulnar nerve compression with finger flexion, anesthesia of the fourth and fifth finger, and motor disorder. Conclusion The main type of fracture-separation of distal humeral epiphysis is metaphyseal fragment (Salter-Harris typeⅡ) in neonates or young children. It is frequently misdiagnosed as a fracture of the lateral humeral condyle, a dislocation of the elbow or others. The anatomy characteristic of elbow joint and auxiliary examination can be used in differential diagnosis. The surgical treatment has significant curative effect. Key words: epiphyseal separation/fracture; child; diagnosis; treatment