Executive Editor: Fergal Monsell General Editor: Chris Colton

Authors: Andrew Howard, Theddy Slongo

Pediatric distal humerus 13-E/1.1

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1 General considerations top


Note: Physeal separation of the distal humerus often occurs as a result of birth trauma. It may also be associated with nonaccidental injury. There is a risk of compartment syndrome associated with management in hyperflexion. Treatment of these injuries can also be technically demanding because of the small size of the child.

Rather than undertaking treatment that could be risky, the surgeon should take into account the considerable potential for modelling of a malunion, particularly in the infant. In practical terms, neonates will not require examination under anesthesia, reduction, or advanced imaging, but are treated with immobilization for comfort.

Children without evidence of fracture callus are often brought to the operating room for examination under anesthesia in order to establish a diagnosis.

Fracture stability and position must be checked, arthrography can be very useful as described in the diagnosis section. If the fracture is found to be stable and in an acceptable position clinically and radiographically, then it can be managed with protective immobilization.

2 Immobilization top


The arm is immobilized in a splint with the elbow in 90° flexion.


Bandaging the arm to the body is comfortable in young children.

v1.0 2016-12-01