Tan W, Wang FH, Yao JH, Wu WP, Li YB, Ji YL, Qian YP. Percutaneous fixation of neonatal humeral physeal fracture: A case report and review of the literature. World J Clin Cases 2020; 8(19): 4535-4543 [PMID: 33083415 DOI: 10.12998/wjcc.v8.i19.4535]
Corresponding Author of This Article
Wei Tan, MD, Attending Doctor, Department of Pediatric Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183 Zhongshan Avenue West, Guangzhou 510630, Guangdong Province, China. tanwei19860724@163.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Wei Tan, Jing-Hui Yao, Wei-Ping Wu, Yi-Bin Li, Yue-Lun Ji, Department of Pediatric Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, Guangdong Province, China
Fu-Hua Wang, The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Yue-Peng Qian, Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Author contributions: Tan W and Wang FH were major contributors in the writing of this manuscript; Tan W, Yao JH, and Li YB performed the diagnostic investigations and treatments; Wu WP, Ji YL, and Qian YP collected the pertinent literature; all authors have read and approved the final version of the manuscript.
Informed consent statement: Consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wei Tan, MD, Attending Doctor, Department of Pediatric Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183 Zhongshan Avenue West, Guangzhou 510630, Guangdong Province, China. tanwei19860724@163.com
Received: March 17, 2020 Peer-review started: March 17, 2020 First decision: July 25, 2020 Revised: July 31, 2020 Accepted: August 25, 2020 Article in press: August 25, 2020 Published online: October 6, 2020 Processing time: 194 Days and 18.8 Hours
Abstract
BACKGROUND
Neonatal distal humeral physeal fractures are rare and difficult to diagnose. Thus, missed diagnoses and delayed healing are possible. Few studies have reported surgical treatment, because a callus may develop at the fracture site 5 d after the fracture, resulting in difficult reduction, and reduction of the limb may cause further physeal injury. Other surgical challenges include the provision of adequate anesthesia and complexity of the operation. However, without appropriate reduction and fixation, a varus elbow deformity may develop. Manual reduction and percutaneous pin fixation are ideal treatment options.
CASE SUMMARY
A 4-day-old neonate with left elbow pain accompanied by limited movement for 4 d was admitted, and diagnosed with delayed physeal fracture of the distal humerus based on physical examination, ultrasonography, and magnetic resonance imaging. The patient was treated by manual reduction combined with percutaneous pin fixation under arthrography. Postoperatively, the reduction was successful. The upper limbs could have been lifted and the fingers could have been moved freely on the second day after the operation.
CONCLUSION
The techniques of manual reduction and percutaneous pin fixation, to treat neonatal distal humeral physeal fractures, are safe and reliable.
Core Tip: Physeal fractures of the distal humerus are rare in the neonate, and can be easily missed or misdiagnosed. Only a few reports of the management of such cases exist. Early diagnosis and treatment can be challenging. In this article, we present the case of a 4-day-old neonate with a left distal humeral physeal fracture, and introduce the use of manual reduction and percutaneous pin fixation under arthrography. Excellent results were achieved in this case. The techniques are an ideal treatment for this injury.
