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Transphyseal elbow fracture in newborn: review of literature

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Abstract

Transphyseal elbow fracture is a rare entity in newborns, and in the last century, only case reports or small case series have been published; however, precise epidemiological data lack. Such fractures occur more often in emergency Caesarian section or vaginal delivery. The differential diagnosis with elbow dislocation can be challenging. Radiography, arthrography, magnetic resonance, ultrasound or a combination of these have already been described to make diagnosis, but guidelines for the management of this injury in the neonate are not well established. A review of the literature of the last century about distal transphyseal fracture of the humerus in newborns was performed. A bibliographic search was conducted accessing usual medical databases. The work-up methods, treatments, results at follow-up and the rate of complications were collected. Twenty case reports or small retrospective case series reporting a total of 33 cases were included. A posteromedial displacement of the radioulnar complex was found in 21 elbows (64 %). Four patients (12 %) underwent surgical treatment, whilst 29 (88 %) were managed without surgery. An attempt of reduction was reported in 23 cases (69 %). At follow-up, 88 % recovered completely the carrying angle and 80 % range of motion. A relationship between the type of treatment (conservative or surgical, with attempt of reduction or not) and results at follow-up could not be demonstrated. The most common complication was cubitus varus. Transphyseal elbow fractures are rare among newborns. Regardless of the treatment choice, such lesions are in most cases associated with a good prognosis.

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Acknowledgments

The authors would like to thank Incarbone V, MD (Dipartimento Di Biotecnologie e Scienze Della Vita, University Of Insubria, Varese, IT) for her support preparing this work and Sommer P, MD (Neurologische Abteilung, Krankenanstalt Rudolfstiftung, Wien, AT) for his help in the bibliographic research.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Dipartimento Di Biotecnologie e Scienze Della Vita, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Segreteria di Ortopedia e Traumatologia, v.le Borri 57, 21100, Varese, Italy

    C. Ratti, N. Guindani & G. Riva

  2. Unità operativa Radiologia B, Ospedale di Circolo e Fondazione Macchi, v.le Borri 57, 21100, Varese, Italy

    L. Callegari

  3. Dipartimento di Scienze della Salute, Università del Piemonte Orientale “A. Avogadro”, A.O.U. “Maggiore della Carità”, Corso Mazzini n. 18, 28100, Novara, Italy

    F. A. Grassi

  4. Dipartimento Universitario Clinico Di Scienze Mediche, Chirurgiche e della Salute. Clinica Ortopedica Traumatologica, Azienda Ospedaliero - Universitaria Ospedali Riuniti di Trieste, Università degli Studi di Trieste, strada di Fiume 447, 34149, Trieste, Italy

    L. Murena

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  1. C. Ratti
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Correspondence to N. Guindani.

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Ratti, C., Guindani, N., Riva, G. et al. Transphyseal elbow fracture in newborn: review of literature. Musculoskelet Surg 99 (Suppl 1), 99–105 (2015). https://doi.org/10.1007/s12306-015-0366-z

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