Fractures In Newborns Research Articles

Ultrasound Diagnosis of Clavicle Fractures in Newborns: A Systematic Review.

Fractures of the clavicle are the most common birth injury among newborns. Aim of this systematic review was to provide a comprehensive analysis of the role of ultrasound (US) in diagnosing clavicular fractures in neonates. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PubMed and Embase, including studies focusing on US in neonatal clavicle fracture. Age at US, number of cases examined by US and X-ray, US and X-ray diagnoses, US probe used, fracture site were systematically extracted. A total of 231 articles were found. We ultimately selected 7 publications that satisfied the inclusion criteria, involving 136 patients examined between 3 days and 3 weeks of age, with 135 confirmed fractures. US was performed on all patients and correctly diagnosed all fractures (135/135, 100%). X-ray was performed on 94/136 patients (69.1%) and correctly diagnosed 89/93 fractures (95.7%). Fracture site was: medial in 2/79, middle in 37/79, and lateral in 40/79. In the remaining 57 cases, site was not reported. This review indicates that ultrasound is extremely reliable in diagnosing clavicle fractures in newborns and should be considered as the gold standard in this context.

Obstetric factors and neonatal outcomes of depressed skull fractures in newborns

PurposeTo determine the obstetric factors affecting the development of depressed skull fracture in neonates.Materials and methodsThis was a retrospectively cohort study on neonates born between July 2016 and August 2021. Neonates diagnosed with depressed skull fractures within one week of birth through X-ray and/or brain ultrasonography were included, and their mothers' obstetric characteristics were reviewed.ResultsThere were 12 cases in 6791 live births. Five women were over 35 years old. All except two were nulliparous. Five cases were delivered from labor induction and others presented with spontaneous labor. Except for two cases, delivery occurred within an hour after full cervical dilatation. Two cases were assisted by vacuum. None displayed fetal distress signs such as low Apgar scores below 7, meconium staining, and umbilical cord pH under 7.2. All depressed fractures were found in the right parietal area. Three cases resulted in focal hyperechoic lesion in brain ultrasonography and two of them showed small hemorrhage-like lesion in magnetic resonance imaging. All depressed skull fractures improved within 6 months in followed X-rays or ultrasonography.ConclusionsThere was no definitely associated obstetric condition for depressed skull fracture of neonates although nulliparous women were majority of the affected cases.

CORRELATION OF MATERNAL SERUM 25 HYDROXY VITAMIN D WITH NEWBORN ANTHROPOMETRY

Vitamin D deficiency (VDD) is identified as a public health problem in many countries, and pregnant women have been identified as a high-risk group, among whom the prevalence of VDD ranges between 20 and 40%. Vitamin D deficiency causes essential health problems, not only in the mother but also in the baby, because the mother's vitamin D stores are the primary source of vitamin D for the fetus. During pregnancy, severe vitamin D deficiency in mothers has been associated with biochemical evidence of impaired bone homeostasis, congenital rickets, and bone fractures in newborns. This study aims to determine the correlation between umbilical cord blood 25(OH)D levels in term pregnancy and Neonatal anthropometry. This research is analytical research using a cross-sectional approach. The sample in this study amounted to 40 people. Data analysts use people tests. The results of this study obtained an average umbilical cord serum 25(OH)D level of 14.70 ± 4.93. There was no correlation between umbilical cord blood 25(OH)D levels in term pregnancy and neonate anthropometry (p>0.05). The average level of 25(OH)D is included in the insufficiency category. Therefore, it is necessary to increase vitamin D supplementation during pregnancy.

Treatment of depressed skull fractures with vacuum devices in the neonatal period: A case series.

The management of depressed skull fractures in infants can be either conservative or surgical. This study aimed to examine the outcomes of management with a negative-pressure vacuum device on depressed skull fractures in newborns. Twenty-eight patients (aged 1-6days) with simple depressed skull fractures underwent skull elevation using negative-pressure vacuum devices. A protocol for nonsurgical management was adopted for infants with such fractures between 2010 and 2023. All patients were initially evaluated with neurological examination and complementary assessments-hematological and coagulation studies, transfontanel transcranial ultrasound, skull radiography, and computed tomography scanning with three-dimensional reconstruction-according to availability and clinical needs. Gentle (negative) extraction pressure was applied with one of several devices (according to institutional availability) for a maximum duration of 60s; this was performed as soon as possible after diagnosis, preferably within 72h. Follow-up data, available in the clinical records, were reported. All patients exhibited satisfactory elevation of the depressed bone without associated injuries, except one patient who presented with an associated cephalohematoma which prevented optimal device coupling to generate sufficient vacuum pressure for correction. Neither neurological deficits nor development of epilepsy was noted; normal neurological assessment and oral alimentation tolerance were confirmed within 24h post procedure. According to our data, ping-pong skull fracture elevation using the vacuum method is a safe and satisfactory treatment in the neonatal period. Early treatment allows for quick resolution, and in our opinion is the strategy of choice for depressed skull fractures in newborns.

Ultrasound Instead of X-Ray to Diagnose Neonatal Fractures: A Feasibility Study Based on a Case Series.

BackgroundFracture is a common birth injury in neonates, and its diagnosis mainly depends on chest X-ray examination, while ultrasound is typically not included in the diagnostic work-up of neonatal fractures. The aim of this study was to investigate the feasibility of using ultrasound to replace X-rays for the diagnosis of fractures in newborns and to determine the ultrasound characteristics of such fractures.MethodsBedside ultrasound with an appropriate probe and scanning angle was performed on 52 newborn infants with suspected fractures based on physical examination findings, and the ultrasound results were compared with the X-ray examination results.ResultsAll 52 infants (100%) showed typical signs of fracture on ultrasound, including 46 cases of clavicle fracture, 3 cases of skull fracture, 2 cases of rib fracture, and 1 case of humerus fracture. Ultrasound was able to detect interrupted cortical continuity, displacement or angulation at the broken end, and callus formation during the recovery period. Chest X-ray examination was performed on 30 patients and identified 96.7% (29/30) of fractures, and the coincidence rate between ultrasound and X-ray was 100%. However, the sensitivity of ultrasound was higher than that of X-ray.ConclusionUltrasound diagnosis of neonatal fracture is accurate, reliable, simple, and feasible. Therefore, it can replace X-ray examinations for the routine diagnosis of common types of neonatal bone fractures.

Clavicular Fractures in Newborns: What Happens to One of the Commonly Injured Bones at Birth?

IntroductionThe clavicle is one of the most commonly injured bones during the birth process. The objective of this study was to determine the frequency and outcome of fractured clavicle amongst neonates born in a five-year period at a Secondary Hospital setting and to determine the Maternal and Neonatal Characteristics involved in such cases and compare them with a control group and determine the significance of any factors.MethodsAll cases of fractured clavicle were retrospectively reviewed in a Secondary care hospital setting during a five-year period from July 2015 to June 2020. Maternal and neonatal factors were determined and then compared to a control group.ResultsOut of 21,435 live births at our center during the study period, 92 infants were diagnosed to have clavicle fractures, giving an incidence of 4.29 per 1,000 live births (0.43%). 89% cases (n=82) were detected before discharge and 11 % cases (n=10) on routine follow-up visit after discharge. Physical examination identified 77% cases (n=71) whereas 23% cases (n=21) were recognized incidentally on X-ray. All babies with fracture including 3 with Erb’s palsy recovered completely without any complications. On logistic regression analysis, spontaneous vaginal delivery, prolonged second stage, vertex presentation, vitamin D deficiency in mothers, birthweight, macrosomia, all were significant risk factors.ConclusionNeonatal clavicular fracture appears to be a transient yet unpredictable and unavoidable event with an overall good prognosis. Only the birth weight was identified as the common risk factor affecting clavicular fracture. Parental concerns and anxiety can be decreased with proper counselling and reassurance.

A retrospective analysis of risk factors for clavicle fractures in newborns with shoulder dystocia and brachial plexus injury: A single-center experience.

We aimed to analyze the risk factors for clavicle fractures in newborns with shoulder dystocia and brachial plexus injury and to determine whether their incidence is associated with local characteristics. This study was conducted as a retrospective trial between January 2017 and December 2018. Patients with clavicular fracture who were hospitalized in the neonatal intensive care unit of a community hospital were retrospectively analyzed. The clavicular fracture cohort was first divided into two groups and then two subgroups: patients with/without shoulder dystocia and patients with/without a brachial plexus injury. Peripartum and neonatal risk factors of these patients were reviewed using the patient information system. Any additional neurological or musculoskeletal trauma was noted. A multivariate logistic regression analysis was performed to determine independent predictors of shoulder dystocia and brachial plexus injury. A total of 46 patients with shoulder dystocia in 25 (54%) and brachial plexus injury in 12 (26%) were included in the study. The birth weight of patients with shoulder dystocia was 4,164.2±412.7 g, and that of patients without was 3,535.8±865.2 g (p=0.003). In 11 of 14 patients (44%) in whom labor was induced and whose infant had a fractured clavicle, the infant also had shoulder dystocia (p=0.029). Brachial plexus injury was found in 8 (66.7%) of 14 infants who were born by induced labor and who had a clavicular fracture (p=0.002). The regression analysis revealed that age and induction of labor were independent risk factors for brachial plexus injury (odds ratio=1.599 and 81.862, respectively). Gestational weight gain (p=0.003) and neonatal birth weight (p=0.047) were also found as independent risk factors for shoulder dystocia. Evidence from this study has shown that not only birth age or birth weight but also excessive weight gain by mother and induction of labor may increase the risk of clavicula fracture with brachial plexus palsy. Advanced maternal age, multiparity, and deliveries after 39 weeks seem to be risk factors for a clavicular fracture with a brachial plexus injury. Level IV, Therapeutic study.

To the treatment of newborn asphyxia

R. considers the Schultze method to be quite expedient, but it cannot always be applied (for example, in low rooms, with bone fractures in newborns), and besides, it is tiring.

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The article presents a literature review on intrauterine bone fractures in fetuses suffering from osteogenesis imperfecta. Prenatal ultrasound investigation of the condition is made to identify pathologically changed bone tissue including shortened and deformed limb segments and ribs, bone fractures and callus formation and widened intracranial sutures. Comprehensive clinical, paraclinical and radiological evaluations are produced after the birth to determine treatment strategy. Skeletal fractures in newborns are treated conservatively. With diagnosis of osteogenesis imperfect established medical treatment with bisphosphonates is administered to inhibit osteoclast-mediated bone resorption, facilitate bone mineralization and lower fracture incidence. The case report describes fractures of both femurs and left tibia in a female newborn suffering from osteogenesis imperfecta type III diagnosed in utero with ultrasonographic screening. The case presented highlights infant’s trauma-focused status, radiological findings and the treatment performed.

Challenging Lower-Extremity Fractures in Newborns and Infants.

Challenging Lower-Extremity Fractures in Newborns and Infants.

Clinical case for the use of intramedullary osteosynthesis in the treatment of pathological fractures of the femur in 6-day newborn girls with a high partial intestinal obstruction

Abstract. Skeletal bone fractures in newborns present a problem of modern traumatology.
 Aim. The goal is to present the use of the method of intramedullary osteosynthesis in the treatment of a pathological fracture of the right femur in a newborn girl to a wide audience of pediatric orthopedic traumatologists.
 Material and methods. We have experience in the treatment of a 6-day-old girl, who was born with intrauterine growth retardation and bowel disease. On the second day of stay in the intensive care unit, she had a pathological fracture of the right femur. Diagnosis of the pathological fracture was established based upon the results of clinical examination and radiography of the injured limb segment.
 Results. Immediately after the diagnosis, the right lower limb of the child was fixed with a plaster bandage. On the control radiographs, the standing of the bone fragments were unsatisfactory, and a decision was made to use the intramedullary osteosynthesis method with a knitting needle on the 6th day after birth of the child. The need for surgical treatment of a fracture of the femur was due to a congenital abnormality of the intestine in the child, and a need to perform surgery on the abdominal organs.
 Discussion. Spontaneous fracture of the right femur occurred in the child in treatment in the intensive care unit. The cause of the fracture was osteopenic syndrome, which developed as a result of vitamin D deficiency. During the first 12 days of her life, the newborn had two laparoscopic operations to address the intestinal pathology.
 Four weeks after the operation using osteosynthesis, the metal from the bone marrow channel of the right femur was removed. After the removal of the needle, the correct axis of the operated segment was fixed to the same length of the lower extremities. The patient had absence of pathological mobility in the fracture region, and full amplitude of movements in the knee and hip joints.
 Conclusion. When receiving fractures of the femur, both traditionally used conservative methods of treatment, as well as surgical methods can be used on newborn children. This is especially true, when a newborn has an accompanying congenital pathology of the internal organs requiring immediate treatment.

Fraturas Ósseas em uma Unidade de Cuidados Intensivos Neonatais

Fractures during the neonatal period are rare. Some fractures, especially long bones, may occur during birth. Moreover, neonates hospitalized in the Neonatal Intensive Care Unit have an increased risk of fractures for several reasons. To evaluate the incidence and characterize fractures in newborns admitted in a tertiary Neonatal Intensive Care Unit. A retrospective analysis of the newborns admitted to the Neonatal Intensive Care Unit with a diagnosis at discharge of one or more bone fractures from January 1996 to June 2013. Eighty neonates had one or more fractures. In 76 (95%) infants the fractures were attributed to birth injury. The most common fracture was the clavicle fracture in 60 (79%) neonates, followed by skull fracture in 6 (8%). In two (2.5%) neonates, extremely low birth weight infants, fractures were interpreted as resulting from osteopenia of prematurity. Both had multiple fractures, and one of them with several ribs. A change in obstetric practices allied to improvement premature neonateâÄôs care contributed to the decreased incidence of fractures in neonatal period. But in premature infants the diagnosis may be underestimated, given the high risk of fracture that these infants present.

Humerus Diaphysis Fracture in a Newborn during Vaginal Breech Delivery.

While most obstetricians are familiar with fracture of the clavicle in newborns during birth, an unlucky minority of obstetricians has encountered long-bone fractures in newborns as well. This complication is traumatic not only for the neonate, but also for the family and the obstetrician; it is also difficult to explain. Fortunately, the long-term prognosis for fracture of the long bones is excellent. Both vaginal and cesarean breech deliveries and maneuvers can be responsible for birth traumas, including long-bone fractures. This case report presents a newborn with breech presentation delivered vaginally that resulted in humerus diaphysis fracture.

Cardiopulmonary resuscitation (CPR)-related posterior rib fractures in neonates and infants following recommended changes in CPR techniques

Posterior rib fractures are highly indicative of non-accidental trauma (NAT) in infants. Since 2000, the “two-thumbs” technique for cardiopulmonary resuscitation (CPR) of newborns and infants has been recommended by the American Heart Association (AHA). This technique is similar to the grip on an infant's thorax while shaking. Is it possible that posterior rib fractures in newborns and infants could be caused by the “two-thumbs” technique? Using computerized databases from three German children's hospitals, we identified all infants less than 12 months old who underwent professional CPR within a 10-year period. We included all infants with anterior–posterior chest radiographs taken after CPR. Exclusion criteria were sternotomy, osteopenia, various other bone diseases and NAT. The radiographs were independently reviewed by the Chief of Pediatric Radiology (MB) and a Senior Pediatrician, Head of the local Child Protection Team (IF). Eighty infants with 546 chest radiographs were identified, and 50 of those infants underwent CPR immediately after birth. Data concerning the length of CPR was available for 41 infants. The mean length of CPR was 11min (range: 1–180min, median: 3min). On average, there were seven radiographs per infant. A total of 39 infants had a follow-up radiograph after at least 10 days. No rib fracture was visible on any chest X-ray. The results of this study suggest rib fracture after the use of the “two-thumbs” CPR technique is uncommon. Thus, there should be careful consideration of abuse when these fractures are identified, regardless of whether CPR was performed and what technique used. The discovery of rib fractures in an infant who has undergone CPR without underlying bone disease or major trauma warrants a full child protection investigation.

Ping pong fractures: treatment using a new medical device

The aim of this study was to assess the use of a new medical device to elevate depressed skull fractures (DSFs) in newborns and minor infants. Nine patients (ranging from 1 day to 9 months of age) with simple DSF underwent skull elevation by a new elevator medical device. This medical device comprises two elements: a pediatric resuscitator (CPR mask) connected to a 50-ml syringe. Pediatric CPR face mask is placed on the depressed region and negative pressure is generated through syringe plunger elevation until fracture reduction is observed. Fracture reduction was confirmed in eight of nine patients by computed tomography scan without underlying brain damage and associated complications. Skull asymmetry was eliminated recovering normal shape. Up to now, there are no neurological concerns. Another treatment was chosen to be applied for one patient who did not respond to manipulation. The new device is a safe, affordable, and effective choice in the treatment of simple depressed skull fractures in newborns and minor infants.

Spontaneous Resolution of Atraumatic Intrauterine Ping-Pong Fractures in Newborns Delivered by Cesarean Section

Two cases of spontaneous intrauterine ping-pong fractures are reported in newborns delivered by cesarean section. Skull fractures occurred with no evidence of extrinsic trauma or cephalopelvic disproportion. Subsequent clinical follow-up at 6 and 12 months revealed normal skull reshaping and growth, with no associated neurological deficits. Spontaneous intrauterine ping-pong fractures in newborns delivered by cesarean section is a distinctly rare condition. These 2 cases demonstrate that, even without complicated spontaneous vaginal delivery or history of external trauma, congenital ping-pong fracture of the skull can occur. The existence of this clinical condition and its spontaneous resolution is important knowledge that can assist in the prepartum and postpartum management of children with this pathology.

Index of Suspicion in the Nursery

A male infant is born at term to a 34-year-old gravida 1 Middle Eastern woman. Prenatal laboratory evaluation documented blood type O-positive, antibody screen-negative, rapid plasma reagin-nonreactive, rubella-immune, human immunodeficiency virus-negative, and group B beta-hemolytic Streptococcus -negative. The woman had undergone in vitro fertilization for the pregnancy. The woman presented in labor with the fetus in breech presentation. During delivery by cesarean section, the infant was noted to be footling breech, and extraction was difficult. Resuscitation was minimal, with warming and drying only. Apgar scores were 9 at 1 and 5 minutes. Physical examination in the delivery room revealed no unusual findings, and the baby was sent to the well baby nursery. The birthweight was 4,062 g. Six hours after his birth, the nurse notes that the infant has bilateral swollen thighs, with the left significantly more swollen than the right. On further evaluation, the infant's right thigh is minimally swollen around an intramuscular injection site without any color change. However, his left thigh has circumferential swelling with mild ecchymosis, taut overlying skin, and edema extending distally past the knee to the lower leg. His temperature is 36.9°C, heart rate is 130 beats/min, respiratory rate is 56 breaths/min, and blood pressure is 73/42 mm Hg. Physical examination reveals a comfortably sleeping infant, who has …

The prognostic value of concurrent clavicular fractures in newborns with obstetric brachial plexus palsy

This study investigates the prognostic value of concurrent clavicular fractures in newborn babies with obstetric brachial plexus palsy. The records of 183 consecutive newborn babies with brachial plexus birth injury from 1988 to 1993 were reviewed retrospectively. Poor outcome, specifically insufficient spontaneous return of motor function of the limb necessitating primary brachial plexus surgery, was assessed for infants both with and without concurrent clavicular fractures. 13 newborn babies had concurrent clavicular fractures, and of these two required primary brachial plexus surgery. On the other hand, surgery was required for 43 of the remaining 170 infants with intact clavicles. Using Fisher's exact test, P = 0.2. Concurrent clavicular fractures in newborns with obstetrical brachial plexus palsy have no prognostic value in predicting spontaneous recovery.

Clavicular Fractures in Neonates: Frequency vs Significance

Sir .—I wish to thank Drs Joseph and Rosenfeld 1 for their evaluation of the frequency and presentation of clavicular fractures in newborns. This is useful information for frontline pediatricians like myself, but I would like to make the following comments. The fact that the occurrence of newborn clavicular fractures has remained stable in the Western world during the past 85 years suggests to me that the New York State Health Department may be on the wrong track if it thinks that this is an indicator of the quality of care. Also, it seems that clavicular fractures are benign occurrences that virtually always heal well without intervention. The only reason then to diagnose clavicular fracture would be to explain irritability with motion or asymmetric Moro's reflexes. That suggests to me that, in children without these symptoms, there may be no reason to make a significant effort to make this diagnosis.

Asymptomatic Clavicle Fractures in Newborns

Asymptomatic Clavicle Fractures in Newborns