Neonatal Fractures

Abstract

A neonatal fracture is a severe complication creating problems regarding diagnosis and appropriate management. Diagnosis from the neonatologist occasionally is difficult. A paediatric orthopaedic surgeon is required to evaluate the neonate, and confirm diagnosis and treatment. Clavicle fracture is the most common injury that must be differentiated occasionally from neonatal brachial plexus palsy. The clinical signs are crepitus, swelling, bony prominence, with the restriction of the movements of the arm. Occasionally, the fracture is diagnosed later. Clavicle pseudoarthrosis is a rare dysplasia. Fracture of the femur or the humerus presents with swelling, crepitus and deformity of the limb, creating difficulties in clothing, bathing and feeding. Most commonly are found in urgent caesarean delivery or complicated dystocia with over-weighted neonates. Bone fragility diseases (osteogenesis imperfecta, hypophosphatasia, arthrogryposis) are diagnosed from neonatal fractures. Conservative treatment with immobilization is the method of choice. Extremely rare is surgical treatment. Premature and low-weighted babies are in high risk to sustain fractures. Epiphyseal fractures of the distal femoral or humeral epiphysis are rare fractures, difficult to be diagnosed initially. They require immediate reduction to avoid permanent lesion of the growth plate. Fractures of forearm, tibia or vertebrae are extremely rare and associated with a bone fragility disease.