Neonatal Displaced Epiphysiolisis of Humeral Head: Case Report

1.      Introduction

Neonatal traumatic epiphysiolisis of the humeral hear is rare, and only a few cases are reported in the literature. [1,2].Incidence of bone injury during the process of delivery is 1 per 1000 live births [3]. In a matter of frequency, the clavicle is the most common bone fractured (45,7%) followed by humerus (20%), femur (14,3%) and depressed skull fracture (11,4%)[3]. Lack of antenatal care, malpresentation often leading to obstructed labor and operative deliveries were found to be risk factors for bone injuries [3].

2.      Case Presentation 

In our case, we present a 1-day old baby girl, without complications during delivery reported, presented left shoulder deformity and flaccid paralysis in her left upper limb(Figure 1&2).

3.      Materials and Methods 

A closed reduction was performed under general sedation in Neonatal Intensive Care Unit. Control radiography and sonography showed a good reduction.The patient was immobilized for 3 weeks with a velpeau, except for physiotherapy exercises. Radiography and Electromyographic(EMG) controls were performed at 1,3 and 6 months(Figure 3&4).

4.      Results

Despite Humeral head ossification nucleus asymmetry, at 6 months, the patient was asymptomatic and recovered full range of movement(Figure 5).

5.      Discussion and Conclusion

·                     Are MRI and EMG necessary to obtain a complete diagnosis and improve our final results?

·                     Early closed reduction looks to be a good method of treatment.

·                     For how long is immobilization mandatory?

·                     Long term evolution of gleno-humeral articulation will be affected by humeral head ossification nucleus asymmetry observed?

Figure 1:1-day old infant presented with left shoulder deformity and flaccid paralysis in her left upper limb.

Figure 2: Diagnostic radiographs showing and displaced epiphysiolysis.

 Figure 3:1-month control radiographs.        Figure 4: 3 months control radiographs

Figure 5: 6 months control radiographs.

1.       Michael JW, Gossmann A, Eysel P, Rutt J (2008) Neonatal traumatic epiphyseolysisof the humeral head. A rare occurrence. Unfallchirurg 111:1017-1020.

2.       Dhillon KS (1985) Neonatal proximal femoral epiphysiolysis (NPFE): a case report. Med J Malaysia 40: 41-43.

3.       Bhat BV, Kumar A, Oumachigui A (1994) Bone injuries during delivery. Indian J Pediatr61:401-405.