Aim of study: Finding the differences between classic distal humeral physeal injuries as radial condylar phy-seal injury, intercondylar fractures or apophyseal injuries and separations of the entire distal humeral epiphysis. To identify a classification of this serious injury according to the age.

Material: Children treated in the Regional Paediatric Trauma Centre, Thomayer Teaching Hospital, Prague during the period of last ten years (1992 – 2001): 14.708 patients with fractures; 1.249 from them with humeral fractures, 875 with distal humeral fractures and 29 with separation of distal humeral epiphysis.

Methods: Retrospective study of all cases with separation of the entire distal humeral epiphysis, diagnostic imaging, methods of treatment and results. Especially pitfalls and their reasons are followed.

Results: Eight fracture-separations were misdiagnosed or not recognised. One half of injuries was operated on either by miniinvasive or open surgery. In all misdiag-nosed cases serious sequels were recorded.

Conclusions: Separation of the entire distal humeral epiphysis has several forms according to ossification of the humerus. The most difficult diagnosis is in young children with cartilaginous periarticular skeleton invisible on X-rays. Stress investigation in general anaesthesia with the use of an image Intensifier or ultrasound imaging can be helpful. However, the knowledge of this type of skeletal injury is not welll known and due to frequent complications can be considered as one of most dangerous fractures in children.