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A neonatal fracture-separation of the distal humeral chondroepiphysis occurred associated with a difficult footling breach delivery. The diagnosis can be predicted when a physical examination of an apparently "dislocated" elbow reveals a normal triangular relationship between the olecranon process and the medial and lateral epicondyles. The injured epiphysis tethered on a wide-based periostium. Acceptable reduction was obtained by alignment of the fracture fragments and avoidance of an abnormal varus or valgus alignment. Healing was rapid, and remodeling as well as range of motion were excellent at six months.
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