Femoral fractures at caesarean section. Case reports

Abstract

Case reportsPatient 1 A 3.3 kg female infant was an extended breech presentation at term. She was born by lower segment caesarean section after labour had failed to progress. There was no difficulty during delivery and the infant's Apgar scores were 9 and 10 at 1 and 5 min, respectively. Examination of the infant on day 1 was normal but on day 6 her mother noticed a tender left leg. The left knee was swollen, tender and movement was limited. The baby was clinically well with a normal temperature. X-ray showed elevation of the periosteum of the distal femur and antibiotic therapy was started on a presumptive diagnosis of septic arthritis. The baby remained apyrexial. Blood cultures were sterile and white cell count and erythrocyte sedimentation rate were normal. Repeat X-rays showed callus formation at the distal end of the left femur, associated with metaphyseal fractures of the femur and upper tibia. Skeletal survey was otherwise normal. Antibiotic therapy was stopped and the baby was discharged. When reviewed 2 weeks later, the swelling and tenderness of the knee had subsided. Patient 2A female infant was born at 40 weeks gestation weighing 4.14 kg. Delivery was by elective lower segment caesarean section for flexed breech presentation in a primigravida. The baby was delivered without any difficulty and cried at birth. Apgar scores were 9 at 1 and 5 min. Routine examination on day 1 was unremarkable. On day 2, the baby was noted to have aswollen right knee but was otherwise well. The knee was warm and tender but there was full movement of the joint. Antibiotics were given and continued until blood Mill Road Maternity Hospital

Classic metaphyseal lesion following external cephalic version and cesarean section

“…CML of the distal tibia has been recently described following orthopedic maneuvers for the treatment of clubfoot, presumably as a result of the iatrogenic application of similar forces [6,7]. Since significant pulling and twisting forces are also necessary for certain obstetrical maneuvers, extremity fractures are a recognized but uncommon complication of breech extraction and cesarean section in particular [3,4].…”

“…The distal femur and proximal tibia are the two areas most often involved, and excessive torsional or shearing forces have been proposed as the likely mechanism of injury [2]. Owing to the substantial pulling and twisting forces involved, extremity fractures are a recognized but uncommon complication of breech extraction and cesarean section in particular [3,4]. We report a case of a classic metaphyseal lesion of the proximal tibia-with a further metaphyseal fracture of the distal femur (probable Salter-Harris II)-following external cephalic version of a frank breech fetus and a subsequent urgent cesarean section.…”

A case of Fracture in a Newborn delivered by Caesarian Section

“…Through the 60's, 70's and 80's, there have been occasional reports of fracture femur, depressed fracture skull, fracture tibia, radius and rarely humerus and these were mostly in difficult breech extraction. There has been apparently no literature on fracture humerus in caesarian neonate in the last decade [1][2][3][4][5][6].…”

Congenital Contractural Arachnodactyly and Femoral Fracture in a Newborn Infant: A Causal Relationship or a Coincidence?

“…14 Femoral fracture even may occur during cesarean delivery. 15,16 On physical examination an obvious deformity of the thigh is seen. As a rule the bone breaks transversely in the upper half or third, where it is relatively thin.…”