Distal Humerus Physeal Separation in Young Children: A Frequently Missed Diagnosis A 2-year-old child fell and landed on the left hand. Post-trauma, he developed swelling over his left elbow and refused to move the left elbow. He was brought to the emergency department and initially diagnosed with left elbow dislocation. A careful study of the plain radiograph of the left elbow showed left distal humerus physeal separation. A gentle closed manipulative reduction was attempted under sedation but failed to achieve good alignment. The child was put under general anaesthesia, where an elbow arthrogram was performed and closed manipulative and percutaneous pinning was done. The child regained full elbow range of motion at 4 months post-injury. At 1 year follow-up, there was no deformity noted. Distal humerus physeal separation is a relatively uncommon presentation and frequently missed diagnosis due to the cartilaginous nature of the distal humerus. It may result in growth disturbance, deformity, and functional limitations.

Chopart’s amputations often have better outcome compared to higher level amputation with limb length preservation, larger weight bearing surface, and lower energy demand. Diabetic Charcot arthropathy and severe foot deformity is a treatment challenge. Reconstructive surgery with hindfoot arthrodesis is viable for plantigrade and stable foot, more fitting for orthotic shoe wear. We described a 62-years old male with underlying type 2 diabetes mellitus, presented with infected left diabetic foot ulcer and treated with Chopart’s amputation. Debridement of the Chopart’s stump was done, the wound healed and patient ambulating with a shoe filler. A year later, he noticed a progressive varus deformity of the left ankle following a trivial fall. He was in pain thus unable to bear weight. The hindfoot was in equino-varus deformity with tight Achilles tendon and uncorrectable, leading to left hindfoot fusion. Patient was able to progress to full weight bearing ambulation with no pain post-operatively.