A difficult delivery of a newborn infant may result in a traumatic separation of the proximal humeral epiphysis from the metaphysis through the physis. When the ossification center of the epiphysis is not yet visible radiographically, the correct diagnosis may be missed and the injury may be mistaken for a dislocation or Erb palsy. As a non-invasive diagnostic method, ultrasonography has proved to be a particularly valuable diagnostic tool.
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Broker et al. (1990) studied this question.