Abstract
Background: perinatal femoral fractures (PFF) are relative rare birth-related fractures. Among treatment options, Bryant traction reported satisfactory outcomes in PFF of children under 3 years of age. The aim of this study is to assess the risk factors, diagnosis, management, and outcome in the 10-year multicentric experiences of all newborns treated for PFF in Catania city hospitals. Methods: 15,628 children, hospitalized in four neonatal units, were retrospectively reviewed. The following data were collected: gender, birth weight, gestational age, presentation, mode delivery, and fracture type according to AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF). In each case, diagnosis was achieved after the clinical examination and X-Ray exam. Each patient underwent Bryant’s skin traction of the affected limb, and was clinically followed for at least two years. Results: eight newborns were included in the study (five males). The average birth weight was 2.656 kg with a gestational age of 37.5 weeks; 4 cases were preterm birth; 5 patients had a cephalic presentation. According to the AO PCCF classification, three fractures were ranked 32-D/4.1 and five were 32-D/5.1. The entire cohort had an excellent outcome. Conclusions: prematurity, low birth weight, and caesarean section could be PFF risk factors. Bryant’s skin traction is an effective option to achieve an excellent outcome.
Highlights
Birth fractures are those diagnosed in the first week of life, in the absence of any postnatal trauma [1]
This study aims to investigate perinatal femoral fractures (PFF) risk factors, diagnoses, management strategies, and outcomes using 10 years of multicentric data on newborns treated for a PFF in Catania city public hospitals, and compares these results with those from studies published in the last 20 years
The birth-related femoral fractures group was composed of eight newborns, five (62.5%) male and three (37.5%) female (Figure 2)
Summary
Birth fractures are those diagnosed in the first week of life, in the absence of any postnatal trauma [1]. Birth-related fractures result from trauma during delivery. The most common sites are the clavicle and humerus and, rarely, the femur [2,3]. The incidence of these fractures is variable and likely underestimated, ranging between 0.1 and 10.5 per 1000 live births [2,4]. Associated risk factors include malpresentation, low birth weight, macrosomia, prematurity, osteogenesis imperfecta, disuse osteoporosis following immobilization, CS [6], difficult extraction (breech presentation), impacted foot in the pelvis, and previous uterine
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