Sreenivas Kalyan Deepak, Abraham Vineet Thomas, Iytha Muni Srikanth, Goutham Praveen, Kumar Ashish, Lavudi Rambabu
Department of Orthopedics, All India Institute of Medical Sciences - Mangalagiri, Guntur, Andhra Pradesh, India.
J Orthop Case Rep. 2025 Jun;15(6):29-33. doi: 10.13107/jocr.2025.v15.i06.5652.
The most common injuries around the elbow are the supracondylar humerus, followed by lateral condyle fractures. Transphyseal separations are uncommon, especially in children older than 3 years. Type 3 Weiss lateral condyle fractures appear similar to transphyseal separations on standard radiographs but have articular incongruity and may need open reduction. In comparison, transphyseal separations often need only closed reduction.
We present a case of injury of the distal humerus in a 4-year-old child sustained due to a fall on the outstretched hand.Diagnoses, Treatment and Outcome: Transphyseal Separation and Lateral condyle humerus fractures were the differential diagnoses. The patient was treated with closed reduction and lateral pinning. The child had complete pain-free movements at the elbow at 3 and 12 months follow-up. With the help of the case report, we describe the importance of intraoperative post-reduction arthrograms to differentiate type 1, type 2 Weiss lateral condyle, and transphyseal separations from type 3 Weiss lateral condyle fractures.
Transphyseal separation of the distal humerus can mimic lateral condyle fracture in children. Proper pre-operative radiographs and intraoperative arthrogram can avoid unnecessary open reduction and complications. This article presents a flowchart to help make a better decision regarding management.
肘部周围最常见的损伤是肱骨髁上骨折，其次是外侧髁骨折。经骨骺分离并不常见，尤其是在3岁以上的儿童中。3型韦斯外侧髁骨折在标准X线片上看起来与经骨骺分离相似，但存在关节面不平整，可能需要切开复位。相比之下，经骨骺分离通常仅需闭合复位。
我们报告一例4岁儿童因伸手撑地摔倒导致肱骨远端损伤的病例。诊断、治疗及结果：经骨骺分离和肱骨外侧髁骨折是鉴别诊断要点。该患者接受了闭合复位及外侧穿针固定治疗。在3个月和12个月的随访中，患儿肘部活动完全无痛。借助该病例报告，我们阐述了术中复位后关节造影对于鉴别1型、2型韦斯外侧髁骨折以及经骨骺分离与3型韦斯外侧髁骨折的重要性。
肱骨远端经骨骺分离在儿童中可能类似外侧髁骨折。合适的术前X线片及术中关节造影可避免不必要的切开复位及并发症。本文提供了一个流程图，以帮助在治疗决策上做出更好的选择。
