Newborns have delicate systems and bone structures that can be harmed if proper care is not observed. Some fractures are unavoidable because of a particularly long labor or excessive pressure when traveling through the birth canal. Others can be caused by too much force applied by the medical professional assisting in the delivery process. Physicians can avert fractures by performing accurate delivery with immediate evaluation of the baby, as well as implementing timely orthopedic procedures during and after delivery.
Babies that present with a cephalohematoma or subarachnoid hemorrhage should be examined for any potential skull fractures. Approximately 10 to 25 percent of cephalohematomas are associated with a skull fracture. This type of fracture tends to be linear and sometimes depressed, typically involving the parietal bones. These fractures are connected to forceful attempts with forceps delivery, can be spontaneous, or are the result of a cesarean delivery. In the case of a skull fracture, neurosurgical consultations are usually highly recommended as a means of determining the extent of the damage and possibly thwarting future health conditions or issues.
Clavicle fractures are the most frequently observed bone fracture resulting from birth trauma and are typically unilateral although bilateral fractures have occurred. Typically, this type of fracture is the result of shoulder dystocia deliveries, breech presentation, or newborns that are large for their gestational period. Most clavicle fractures are greenstick; however, they can occasionally be complete, especially in the case of forceful manipulations of the arm and shoulder. This type of fracture can sometimes be confused with brachial plexus palsy, congenital pseudoarthrosis, and congenital muscular torticollis; making accurate diagnosis and treatment paramount to a healthy recovery. The majority of neonatal clavicle fractures are diagnosed at discharge or during the first follow-up visit.
While somewhat uncommon, squeezing and lateral compression of the rib cage can result in a fracture during birth and delivery. A recommended neonatal assessment of such an injury typically starts with palpations of the ribs and observing infant response.
Certain factors can increase the risk of birth fractures, including:
- Forceful obstetric maneuvers during delivery
- Prolonged labor
- Macrosomia, when a fetus is larger than normal for their gestational age
- Breech presentation
- Shoulder dystocia
- Forceps and vacuum-assisted deliveries
Palpations will typically reveal tenderness and irregularity in bone structure, which can then be confirmed by radiograph images. Diagnosing certain types of birth injury fractures can be difficult as they can sometimes be asymptomatic. Fractures heal at variable rates and timing injuries to determine exactly when they occurred from radiographic images can sometimes be difficult.
Treatment for the fracture will be dependent on the location and severity of the fracture. Hairline and greenstick fractures may be allowed to heal on their own, whereas simple or compound fractures may require surgery or stabilization through a cast or sling. A special device known as a Bryant skin traction is normally used in the case of femur fractures, and is a sling-like device that allows the bones to fuse. The Bryant skin traction devices are typically administered in the hospital and include prolonged stays of two to three weeks. Another similar device in which the baby can be discharged is called a Pavlik harness; however, allowing infants to be discharged in such an apparatus should be accompanied with frequent follow-up appointments and careful observation on the part of both parents and the baby’s physician.
Barry P W, Hocking M D. Infant rib fracture-birth trauma or non-accidental injury. Arch Dis Child. 1993 February; 68(2):250.
Dias E. Bilateral humerus fracture following birth trauma. Journal of Clinical Neonatology.2012 January-March, 1(1):44.
Givon U, Sherr-Lurie N, Schindler A, Blankstein A, Ganel A. Treatment of femoral fractures in neonates. IMAJ. 2007; 9:28-29.
Hughes C, Harley EH, Milmoe G, Bala R, Martorella A. Birth trauma in the head and neck. Arch Otolaryngol Head Neck Surg. 1999;125(2):193-199.
Kanik A, Sutcuoglu S, Erdemir A, Ozer E A. Bilateral clavicle fracture in two newborn infants. Iranian Journal of Pediatrics. 2011 December; 21(4):553-555.
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