• Shawn R Gilbert and Michael J Conklin.
• Department of Surgery, Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA. shawng@uab.edu
• Pediatr Emerg Care. 2007 Nov 1; 23 (11): 816819816-9.

ObjectivesThe study was undertaken to describe the presenting features of children with physeal separation of the distal humerus and review the radiographic features of the diagnosis.MethodsThe charts of all children with elbow injuries aged 3 or younger were reviewed to find those with distal humerus physeal separation. Presenting complaint, initial diagnosis, and time to correct diagnosis were recorded.ResultsOf 101 children aged 3 or younger with elbow fractures, 7 were noted to have distal humerus physeal separation. All patients presented with pain, swelling, or disuse. Two cases resulted from suspected or confirmed nonaccidental injury. In no case was a diagnosis of distal humerus physeal separation assigned by the emergency physician or radiologist. Delay in assignment of final diagnosis ranged from 2 to 14 days.ConclusionsPhyseal separation of the distal humerus is an unusual injury but accounts for a significant number of elbow fractures in children 3 or younger. Attention to the radiographic relationship of the ulna and humerus and an appropriate index of suspicion are keys to diagnosis. Nonaccidental injury should be considered as an etiology.

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