Imaging Evaluation of Distal Humeral Epiphyseal Separation in Newborns: Diagnostic Pitfalls and Challenges

ABSTRACT Distal humerus epiphyseal separation (DHES) is a rare orthopedic condition that mainly occurs in children younger than 2 years of age as a consequence of birth‐related trauma, especially in newborns and infants. Diagnosis is challenging, particularly when initial imaging is obtained at an outside facility and interpreted by general radiologists rather than pediatric specialists. Ultrasound (US) plays a crucial role in diagnosing DHES, as it visualizes the non‐ossified cartilaginous epiphysis—often missed on plain radiographs—and confirms displacement when x‐rays show only indirect signs like the posteromedial shift of the radius and ulna. We report a case of DHES in a clinically symptomatic 7‐day‐old newborn, with the purpose of emphasizing the complementary roles of plain radiography (x‐ray), US and magnetic resonance imaging (MRI) in providing a multimodal imaging approach.