Fracture of the Femur of A Newborn after Cesarean Section for Breech Presentation and Fibroid Uterus : A Case Report and Literature Review

Abstract

Introduction:The practice of cesarean section is known to decrease the occurrence of long bone fractures. We present here an unusual diaphyseal fracture of the femur of a newborn after cesarean section, the only case observed in our 14 years of practice.Case Report:The patient was a 3.4-kg female child born at 38 weeks of gestation. The mother was a primipara and aged 39 years. Ultrasound examination at 20th week revealed intrauterine fibroids with a breech presentation. Therefore, elective cesarean section was indicated. There was no apparent bone disorder that could predispose to sustain femur fracture. The fracture was treated successfully with a bilateral spica cast. The cesarean section was indicated in an aged primipara, bearer of uterine fibroids, and breech presentation. She had a good general health status, but her bone density was unknown since this examination is not routinely performed in our clinical settings in Africa.Conclusion:Elderly age, primipara status, presence of uterine fibroids, and breech presentation are usual indications for cesarean section. However, there are not many reports on femur fracture after cesarean section. Our present case suggests that despite the latest advances in delivery techniques, cesarean section for breech presentation predisposes the neonate to femoral fractures.

Femur Shaft Fracture in Newborns: A Report of Two Cases

“…In newborns following Caesarean section, fractures themselves are usually located in the shaft of the femur and are of spiral nature [ 4 ]. The predisposing factors are low or high birth weight, advanced age of the mother, preterm delivery, and uterine fibrinomas [ 5 ]. Emergency Caesarean delivery carries a higher risk of long bone fracture than vaginal delivery.…”

Spontaneous fetal femoral fracture: a case report and literature review

“… 13 – 15 Thirdly, caesarean section, which is suited for situations such as older mothers, primipara status, presence of uterine fibroids and breech presentation, can increase the risk of femoral fractures. 15 , 16 Finally, spontaneous fetal femoral fracture, which is an extremely rare condition diagnosed on the basis of ruling out all of the factors described above. Several cases have been reported including skull fractures, 17 , 18 femoral fractures, 1 – 4 and fractures of the tibia and fibula.…”

Fractures of long tubular bones in newborns: mechanisms of injuries, methods of diagnosis, and treatment

“…Причинами родовой травмы костей скелета у новорожденных чаще всего служат пособия, применяемые акушерами-гинекологами и акушерками как во время родов через естественные родовые пути [11,12], так и при проведении оперативного родоразрешения [13][14][15][16][17]. При этом нет единой точки зрения на вопрос, какой из методов родовспоможения -естественный или оперативный -наиболее опасен в отношении получения ребенком родовой травмы.…”