Abstract

Reasons for impaired function of the upper extremity in the newborn are either congenital (eg, dysplasia) or caused by obstetric trauma such as clavicle fracture, humerus epiphysiolysis, plexus palsy, or dislocated elbow joint.

After an unsuccessful attempt to reduce her subluxated left elbow joint a 2-day-old baby was transfered to our department straight from the orthopaedic operating room table of a district hospital. On first examination the elbow joint was swollen, the range of movement painfully restricted and additionally a slight plexus palsy was observed. Dislocated, non-articulating elbow joint surfaces were detected in initial x ray films. Magnetic resonance imaging scans in this case were inconclusive in contrast to a non-incidental case in a 4-month-old baby, whereas ultrasound scans revealed the fracture line and slipped epiphysis in both cases.

The dislocated epiphysis was reduced in analgosedation under ultrasound control before an 8-shaped plaster sling was applied. Two weeks later the sling was removed and physiotherapy started. Follow-up was done by ultrasound easily and exclusively. Three months later correct joint alignment and regular bony healing on x ray films and ultrasound scans. Only slightly restricted range of movement.

In conclusion, especially in the neonatal case, ultrasound was the most valuable tool for diagnosis of the slipped distal humerus epiphysiolysis making most benefit out of its advantages: bedside availability, dynamic mode, non-invasiveness, lack of radiation and avoidance of general anaesthesia.