Fracture-separation of the distal humeral epiphysis. Long-term follow-up of five cases.

Fracture-separation of the distal humeral epiphysis is a rare injury described in young children. The diagnosis is often difficult because most of the ossification centre are not visible. We report a long-term follow-up study of five cases, evaluated after an average of 38 years. At the time of fracture, all the patients were more than 3 years old. Three patients had been treated with overhead traction, closed reduction and immobilisation in a long-arm plaster cast, one patient with closed reduction and immobilisation and another one, initially not diagnosed, had been treated after 2 weeks with only immobilisation in a long-arm plaster cast. Cubitus varus deformity was observed in one of the five patients. In the remaining four cases the cubitus was less valgus than the opposite side. No patient complained of any functional disability even though in two of them, one treated late and another one who had an inadequate reduction, radiographic signs of degenerative arthritis were present. We believe that the amount of displacement of the fragments, the quality of the reduction and the age at the time of fracture are important factors influencing the development of cubitus varus deformity.