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DOI: 10.1055/a-0891-1168
Ellbogenluxation bei Geburt? – Differenzialdiagnose von Ellbogenpathologien bei Geburt
Elbow Luxation at Birth? – Differential Diagnosis of Elbow Disorders presenting at BirthPublication History
eingereicht 12 November 2018
angenommen nach Überarbeitung 28 March 2019
Publication Date:
16 May 2019 (online)
![](https://www.thieme-connect.de/media/zgn/201904/lookinside/thumbnails/12-2018-0216_10-1055-a-0891-1168-1.jpg)
Zusammenfassung
Wir berichten einen Fall von isolierter Kongenitaler Radiusköpfchenluxation (kRKL) bei einem Neugeborenen nach vaginaler Geburt aus Beckenendlage. Die Assoziationen dieser Geburtsmodalität führten zu der Fehldiagnose einer Ellbogenluxation. Die Ellbogenluxation ist eine häufige Fehldiagnose der kRKL, obwohl sie insbesondere bei Kindern unter einem Jahr bisher nicht berichtet wurde. Für den erfahrenen Kliniker führen jedoch die wiederholte klinische Untersuchung zusammen mit der geeigneten Bildgebung zum Ausschluß dieser Diagnose. Die kRKL kann bis in das Jugendalter asymptomatisch bleiben. Sofern keine Schmerzen oder funktionelle Beeinträchtigung vorliegen ist keine Therapie notwendig. Wir nahmen diesen Fall zum Anlass, neonatale Ellbogen-Auffälligkeiten in diesem Bericht zusammenzufassen.
Abstract
This is a case report of an isolated congenital radial head dislocation (CRHD) presenting after a breech delivery. The implications of this delivery mode led to the misdiagnosis of an elbow luxation. We found that elbow luxation is a common misdiagnosis of CRHD, although it has not been reported in children younger than one year. For the experienced clinician, repeated examinations and appropriate imaging usually lead to the exclusion of such misdiagnoses. CRHD itself usually remains asymptomatic until adolescence. Without pain or functional impairment of the joint, no specific therapy is needed. This case prompted us to provide an overview of elbow pathologies presenting at birth.
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References
- 1 Rahul P, Grover AR, Ajoy SM. Bilateral Humerus and Right Femur Fracture in a Newborn after Cesarean Section for Breech Presentation in a Twin Pregnancy: A Very Rare Case Report. J Orthop Case Rep 2017; 7: 9-11. doi: 10.13107/jocr.2250–0685.664
- 2 Rasenack R, Mollmann C, Farthmann J. et al. Fractures in neonates as a result of birth trauma caused by caesarean section. Z Geburtshilfe Neonatol 2010; 214: 210-213. doi: 10.1055/s-0030–1261937
- 3 Ehrenfest H. Birth injuries of the child. New York: D. Appleton and Company; 1922
- 4 Hannah ME, Hannah WJ, Hewson SA. et al. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet 2000; 356: 1375-1383
- 5 Rockwood CA WK, King RE. Fractures in Children. 4th. Aufl. 1996
- 6 Marzi I. Kindertraumatologie. 3. Aufl. Springer; 2016
- 7 Josefsson PO, Nilsson BE. Incidence of elbow dislocation. Acta Orthop Scand 1986; 57: 537-538
- 8 Frongia S, Günther P, Romero P, Keßler M, Holland-Cunz S. Ellbogenluxationen im Kindesalter – eine Langzeitbeobachtung. Unfallchirurg 2010; DOI: 10.1007/s00113–010–1858–9:. 1–7. doi:10.1007/s00113–010–1858–9
- 9 Rasool MN. Dislocations of the elbow in children. J Bone Joint Surg Br 2004; 86: 1050-1058
- 10 Isaac SM, Danial I, Modi A. Isolated posterior elbow dislocation in a one-year-old child: a case report. Acta Orthop Belg 2009; 75: 133-135
- 11 Dharmshaktu GSSA, Khan I. Elbow dislocation in a 3 year old child: a report of a rare injury. Int J Contemp Pediatr 2015; 254-256
- 12 Carey RP. Simultaneous dislocation of the elbow and the proximal radio-ulnar joint. J Bone Joint Surg Br 1984; 66: 254-256
- 13 Bonnaire Metzger. Ann de gynéc et d'obst, Par 1910-01; 236–237
- 14 Gigante C, Kini SG, Origo C. et al. Transphyseal separation of the distal humerus in newborns. Chin J Traumatol 2017; 20: 183-186. doi:10.1016/j.cjtee.2017.04.003
- 15 Sherr-Lurie N, Bialik GM, Ganel A. et al. Fractures of the humerus in the neonatal period. Isr Med Assoc J 2011; 13: 363-365
- 16 Camera U. Total, pure, traumatic detachment of inferior humeral epiphysis. Chir Org Mov 1926; 294-316
- 17 Jacobsen S, Hansson G, Nathorst-Westfelt J. Traumatic separation of the distal epiphysis of the humerus sustained at birth. J Bone Joint Surg Br 2009; 91: 797-802. doi:10.1302/0301–620×.91B6.22140
- 18 Siffert R. Displacement of the distal humeral epiphysis in the newborn infant. J Bone Joint Surg Am 1963; 45: 165-169
- 19 Bayne O, Rang M. Medial dislocation of the radial head following breech delivery: a case report and review of the literature. J Pediatr Orthop 1984; 4: 485-487
- 20 Ziv N, Litwin A, Katz K. et al. Definitive diagnosis of fracture-separation of the distal humeral epiphysis in neonates by ultrasonography. Pediatr Radiol 1996; 26: 493-496
- 21 Patil MN, Palled E. Epihyseal Separation of Lower end Humerus in A Neonate-Diagnostic and Management Difficulty. J Orthop Case Rep 2015; 5: 7-9. doi:10.13107/jocr.2250–0685.332
- 22 Ratti C, Guindani N, Riva G. et al. Transphyseal elbow fracture in newborn: review of literature. Musculoskelet Surg 2015; 99 (Suppl. 01) S99-S105. doi:10.1007/s12306–015–0366-z
- 23 Von Laer LR. Frakturen und Luxationen im Kindesalter. 4. Aufl. Georg Thieme Verlag; Stuttgart – New York: 2001
- 24 Knudsen CJ, Hoffman EB. Neonatal osteomyelitis. J Bone Joint Surg Br 1990; 72: 846-851
- 25 Mardam-Bey T, Ger E. Congenital radial head dislocation. J Hand Surg Am 1979; 4: 316-320
- 26 McFarland B. Congenital Dislocation of the Head of the Radius. BJS 1936; 24: 41-49
- 27 Kelly DW. Congenital dislocation of the radial head: spectrum and natural history. J Pediatr Orthop 1981; 1: 295-298
- 28 Al-Qattan MM, Abou Al-Shaar H, Alkattan WM. The pathogenesis of congenital radial head dislocation/subluxation. Gene 2016; 586: 69-76. doi:10.1016/j.gene.2016.04.002
- 29 Zakany J, Duboule D. The role of Hox genes during vertebrate limb development. Curr Opin Genet Dev 2007; 17: 359-366. doi:10.1016/j.gde.2007.05.011
- 30 Echtler B, Burckhardt A. Isolated congenital dislocation of the radial head. Good function in 4 untreated patients after 14–45 years. Acta Orthop Scand 1997; 68: 598-600
- 31 Reichenbach H, Hormann D, Theile H. Hereditary congenital posterior dislocation of radial heads. Am J Med Genet 1995; 55: 101-104. doi:10.1002/ajmg.1320550124
- 32 Gattey PH, Wedge JH. Unilateral posterior dislocation of the radial head in identical twins. J Pediatr Orthop 1986; 6: 220-221
- 33 Lyons Jones K. SDW. Smith's Recognizable Patterns of Human Malformation. Philadelphia: Elsevier Saunders; 2006
- 34 Marden PM, Smith DW, McDonald MJ. Congenital Anomalies in the Newborn Infant, Including Minor Variations. A Study of 4,412 Babies by Surface Examination for Anomalies and Buccal Smear for Sex Chromatin. J Pediatr 1964; 64: 357-371