Neonatal Physeal Separation of Distal Humerus During Cesarean Section
Diagnosing physeal separation of the distal humerus in a newborn can be challenging. Skeletal immaturity and absence of secondary ossification centers make radiographic diagnosis difficult for inexperienced providers. This fracture is seen in the setting of complicated deliveries with excessive traction and rotation applied to the forearm.
We report a case of physeal separation of the distal humerus in a newborn as a complication of cesarean section and describe the intervention used and the short-term results.
As our patient’s instability was noted during surgery, we performed percutaneous pinning after arthrography-assisted closed reduction. We considered using 2 lateral pins for fixation, but, after the first pin was placed, fluoroscopic stress testing with the patient under anesthesia demonstrated adequate stability. A second, smaller pin could have been used to control rotation, if needed. Medial pin placement that avoids the ulnar nerve is difficult in the newborn elbow; medial pins should probably be avoided in the newborn, if possible.
Early diagnosis and treatment are essential. Late diagnosis was reported to lead to complications such as varus deformity and restriction of joint ROM.4
Our patient healed without any complications and achieved full ROM. Long-term follow-up is needed to diagnose any physeal bar that might lead to secondary deformities.
Conclusion
Cesarean section is reported to reduce birth complications, but it might cause fractures of the femur and humerus.1 Avoiding application of excessive traction to the forearm can prevent physeal separation of the distal humerus. This entity should be kept in mind as a potential complication of cesarean section. Arthrography is helpful in treatment and may help avoid unnecessary open reduction.
