Congenital depressed skull fracture in the absence of trauma: case report and literature review

Abstract

There are limited reports of neonatal depressed skull fractures in the absence of any known trauma or obvious risk factors. Here we describe a male neonate with a significant frontal nontraumatic depressed fracture, his course of treatment, and a literature review. A male neonate was attended for a significant congenital depressed skull fracture in the left frontal bone. He was born full term after an uncomplicated delivery to a multiparous mother who was a human immunodeficiency syndrome (HIV)-positive immigrant from sub-Saharan Africa. The pregnancy was otherwise uncomplicated. There was no history of trauma to the mother during the pregnancy or delivery. Ultrasonography had been unremarkable. No other abnormalities were noted. The patient was brought to the operating room at the age of 13 days for elevation of his fracture due to its nonreducible nature. A small linear incision was made just posterior to the coronal suture. The dura mater was stripped and a combination of Penfield and periostial elevators was used to elevate the depressed fracture. Nontraumatic depressed skull fractures are uncommon in neonates. The cause of this entity has not been identified, and many theories about its origin have been proposed. Treatment can be either surgical or conservative.

Successful Non-Operative Treatment of Congenital ‘Pin-Pong’ Fracture in a Newborn Delivered by Caesarean Section

“…Congenital pin-pong fracture is an uncommon neurosurgical condition seen mostly in African women as in the index case [13,15]. It commonly involves the parietal area on the right side similar to the present report [4,11].…”

“…Also, fetal head pressure against maternal pelvic mass like fibroid or tumour may results in pin-pong fracture [3]. Cranial computerised tomography scan is the preferred imaging modality in evaluation of bone abnormality like pin-pong fracture [13]. The treatment of pin-pong fracture remains controversial [3,6].…”

“…Both non-operative and operative modalities were described depending on the neurological status of the patient and radiological characteristics of the depression. [1,6,13,14] The objective of this paper was to report a successful treatment of congenital pin-pong fracture in a New-born using a watchful waiting strategy.…”

Congenital depression of the skull in a neonate

“…In view of absence of the mentioned indications for surgical intervention, where there was no obvious brain parenchymal injury or compression, dural tears, or bone fragments, our case was managed conservatively and followed with a good outcome. The outcome, thus, is favourable in the absence of underlying abnormalities 7. Developmental delay is rarely reported and is likely to be the result of insults to the brain resulting directly from the original trauma.…”

Birth trauma in newborns

“…Это сопровождается сдавлением головки плода костным тазом матери (со стороны V поясничного позвонка, седалищных отростков, крестцового мыса и лобкового симфиза, асимметричного таза), что приводит к деформации черепа [48], вдавливанию теменных или лобных костей черепа, способному вызвать нарушение целостности коры головного мозга [45,49,50]. Другие факторы риска включают внешнюю травму живота матери, синдром Элерса-Данло и врожденные нарушения остеогенеза [51]. Приобретенные (ятрогенные) чаще всего развиваются при родоразрешении акушерскими щипцами или вакуум-экстракцией плода [47].…”