Neonatal distal humeral physeal separation during caesarean section: a case report and review of a literature

In children, fracture-separation of the epiphyseal plate near the elbow joint is a common occurrence. However, separation of the distal humeral epiphysis is very rare, especially in the newborn. There have been very few reports of this rare injury since 1926. When it occurs in the newborn, it may be difficult to diagnose and is easily mistaken for a dislocation of the elbow. Caesarean deliveries with considerable traction applied to extract the baby can be the risk factor of such injury. The unimpressive clinical appearance of such injury of the elbow, as well as the absence of ossific nuclei of the distal humerus in the newborn is responsible for the dilemma in making the diagnosis. The correct diagnosis was made from plain radiographs and often supplemented with ultrasonography, magnetic resonance imaging (MRI), and arthrography. Opened reduction with percutaneous Kirschner wire fixation is one of the treatments of choice for these injuries. In this article, we report a rare injury of distal humeral epiphyseal separation in a newborn during a caesarean section.