Age / Sex : 8 / F

Chief complaint : painful swelling of left elbow after abuse

What is your impression? 

Two weeks later, you can see the final diagnosis with a brief discussion of this case. (Please submit only one answer)

Courtesy : Jaehyuck Yi, Kyungpook National University Hospital

Distal humeral epiphyseal separation with metaphyseal fracture

Discussion

Findings:

Simple
radiograph

-      
displaced
fracture of posterior metaphysis of the distal humerus

MRI

-      
posteriorly
displaced trasnsphyseal fracture of the distal humeral epiphysis

Differential Diagnosis:

Diagnosis:
 

Distal
humeral epiphyseal separation with metaphyseal fracture

Discussion:

-      
Usually
occurred in children younger than 2 years

-      
Related to
birth trauma, child abuse

-      
If only
epiphyseal lesion that is not visualized on simple radiograph, may delay in
diagnosis and treatment → need to further diagnostic
evaluations including USG and MRI

References:

1. Distal
humeral epiphyseal separation in young children: an often-missed
fracture-radiographic signs and ultrasound confirmatory diagnosis. Nucharin
Supakul et al. AJR 2015;204:W192-W198