Neonatal Separation of Distal Humeral Epiphysis during Caesarean Section: A Case Report

Sabat, Dhananjaya; Maini, Lalit; Gautam, VK

doi:10.1177/230949901101900325

Cited by 21 publications

(19 citation statements)

References 11 publications

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“…Some case reports or small case series have already been published; however, precise epidemiological data lack [1][2][3][4]. In a retrospective analysis of 105,119 births, 789 (0.75 %) of the neonates were found to have a fracture, but only one patient (0.0001 %) had a transphyseal fracture of the humerus [5].…”

Section: Introductionmentioning

confidence: 99%

Transphyseal elbow fracture in newborn: review of literature

et al. 2015

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Transphyseal elbow fracture is a rare entity in newborns, and in the last century, only case reports or small case series have been published; however, precise epidemiological data lack. Such fractures occur more often in emergency Caesarian section or vaginal delivery. The differential diagnosis with elbow dislocation can be challenging. Radiography, arthrography, magnetic resonance, ultrasound or a combination of these have already been described to make diagnosis, but guidelines for the management of this injury in the neonate are not well established. A review of the literature of the last century about distal transphyseal fracture of the humerus in newborns was performed. A bibliographic search was conducted accessing usual medical databases. The work-up methods, treatments, results at follow-up and the rate of complications were collected. Twenty case reports or small retrospective case series reporting a total of 33 cases were included. A posteromedial displacement of the radioulnar complex was found in 21 elbows (64 %). Four patients (12 %) underwent surgical treatment, whilst 29 (88 %) were managed without surgery. An attempt of reduction was reported in 23 cases (69 %). At follow-up, 88 % recovered completely the carrying angle and 80 % range of motion. A relationship between the type of treatment (conservative or surgical, with attempt of reduction or not) and results at follow-up could not be demonstrated. The most common complication was cubitus varus. Transphyseal elbow fractures are rare among newborns. Regardless of the treatment choice, such lesions are in most cases associated with a good prognosis.

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Section: Introductionmentioning

confidence: 99%

Transphyseal elbow fracture in newborn: review of literature

et al. 2015

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“…In 2009 Jacobsen et al 4 reviewed a series of 6 neonatal chondroepiphyseal injury in addition to 22 previous cases reported in the literature. Since then there have been only 14 cases further quoted 5, 7, 8, 9, 10, 11, 12, 20…”

Section: Discussionmentioning

confidence: 99%

“…In a historical review of 30 years of experience, Madsen 3 documented only one case of distal humeral epiphysis separation in 105,119 neonates. In the literature there is only sporadic cases or small case series reported 4, 5, 6, 7, 8, 9, 10, 11, 12. This lesion may be easily missed at birth, due to clinical and radiographic difficulty in diagnosis 13 .…”

Section: Introductionmentioning

confidence: 99%

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Transphyseal separation of the distal humerus in newborns

Gigante

Kini

Catena³

et al. 2017

Chinese Journal of Traumatology

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Obstetric traumatic separation of the distal humeral epiphysis is a very uncommon injury, which presents a diagnostic challenge. These case serials reviewed the functional outcomes of 5 patients who had sustained a fracture-separation of the distal humeral epiphysis at birth. The diagnosis was made at a mean time of 40.8 h after delivery. All the patients were treated with gentle close manipulation, reduction under fluoroscopy and above-elbow cast application. After discharge, the patients were followed up for a mean of 30 months. Clinico-radiological results were excellent in four patients. One case necessitated closed reduction and percutaneous K-wire fixation at one week follow-up due to failed reduction. Cubitusvarus deformity was the only complication noted in 1 case. Good functional outcome can be expected in newborns with fracture-separation of the distal humeral epiphysis wherein the physis is anatomically reduced.

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“…Este tipo de fraturas, bem como as do fémur estão muitas vezes associadas a cesarianas, durante a extração dos membros. [10][11][12][13] Contudo, nós verificamos apenas um RN com fratura do úmero que nasceu de cesariana, sendo que nos três restantes, o parto foi eutócico mas com extrações referidas como difíceis. O mesmo se verificou nas fraturas de fémur, em que apenas um dos três casos foi parto por cesariana.…”

Section: Discussionunclassified

Fraturas Ósseas em uma Unidade de Cuidados Intensivos Neonatais

et al. 2015

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RESUMO Material and Methods: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. Results: 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. Conclusion: A change in obstetric practices allied to improvement premature neonate's 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. Keywords: Fractures, Bone/epidemiology; Infant, Newborn; Intensive Care Units, Neonatal; Portugal. INTRODUÇÃOAs fraturas ósseas são raras no período neonatal. 1 No entanto, durante o parto podem ocorrer fraturas de ossos longos, nomeadamente da clavícula, associada a eventos como a distocia de ombros, bem como fraturas cranianas, na grande maioria dos casos decorrentes do uso de fór-ceps ou ventosa.2 Por outro lado, os recém-nascidos (RNs) internados em Unidades de Cuidados Intensivos Neonatais (UCIN) têm um risco aumentado de fraturas ósseas por várias razões incluindo prematuridade, baixo peso ao nascimento, malnutrição, traumatismo secundário a intervenções médicas bem como a efeitos colaterais de fárma-cos. [1][2][3][4][5] No RN pré-termo, a causa específica da fratura é geralmente difícil de estabelecer, sendo muitas vezes atribuída à osteopenia da prematuridade. 1 A maioria dos casos são identificados acidentalmente em radiografias feitas por outras razões, pelo que a incidência exata das fracturas nos prematuros é desconhecida.2 De acordo com os poucos estudos publicados, a incidência das fraturas é muito variável, entre 1,2 a 10,5%, sendo maior em RNs de muito baixo peso (MBP). 1,6 O objetivo deste estudo foi avaliar a incidência e caracterizar as fraturas ósseas nos RNs internados numa UCIN nível III, com o propósito de otimizar as melhores práticas preventivas e terapêuticas.

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Neonatal Separation of Distal Humeral Epiphysis during Caesarean Section: A Case Report

Abstract: We report a rare injury of distal humeral epiphyseal separation in a newborn during a Caesarean section. The diagnosis was made using magnetic resonance imaging. Emergency Caesarean deliveries with considerable traction applied to extract the baby can be the risk factor of such an injury.

Cited by 21 publications

References 11 publications

Transphyseal elbow fracture in newborn: review of literature

Transphyseal elbow fracture in newborn: review of literature

Transphyseal separation of the distal humerus in newborns

Fraturas Ósseas em uma Unidade de Cuidados Intensivos Neonatais

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