Spontaneous Intrauterine “Ping-Pong” Fracture: Review and Case Illustration

Abstract

We report a case of a closed outer-table parietal "ping-pong" skull fracture occurring in a 4 190-gram female infant born at 39 weeks and 5 days gestation after an uneventful Cesarean section (Apgar scores of 9 and 9 at one and five minutes). There was no maternal history of abdominal trauma during pregnancy and there were no complications or difficulties with Cesarean section delivery. Neurological examination was normal. Computed tomography with three-dimensional reconstruction images showed a 4 x 5 cm depression in the right parietal bone with a medial lucency consistent with a fracture of the superior margin of the skull and leftward deviation of the sagittal suture and sinus. Spontaneous resolution did not occur by one month of age and the skull fracture was repaired with excellent cosmetic results. Rarely has a case of spontaneous intrauterine skull fracture been reported in an atraumatic Cesarean delivery. We believe this fracture resulted from a chronic in utero process without associated trauma as evidenced by deviation of the sagittal suture and sinus.

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

“…It commonly involves the parietal area on the right side similar to the present report [4,11]. In contrast to some Authors, congenital pin-pong fracture usually affects the frontal area in the Africans and parietal region in Western countries [15]. Several aetiological factors related to both the mother and the baby, but none was identified in our patient.…”

“…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].…”

Spontaneous Resolution of Atraumatic Intrauterine Ping-Pong Fractures in Newborns Delivered by Cesarean Section

“…Skull deformities in neonates are generally discovered during the delivery process, although several cases have been discovered before delivery, [4][5][6][7][8] and in 1 occasion during vaginal examination. 11 A contracted pelvis is the most commonly reported etiology for congenital skull depressions (60%).…”

“…However, skull depressions have been reported in uneventful vaginal deliveries without noticeable signs of trauma and in cesarean sections. [3][4][5][6][7][8] These observations have further complicated the etiology of congenital moulding depression of the skull, suggesting that intrauterine events before delivery can result in these deformities. 9,10 We report 2 cases of spontaneous intrauterine ping-pong fractures in newborns delivered by cesarean section in which immediately after the delivery the gynecologists and obstetricians were threatened with malpractice by the newborns' parents.…”

Fractura - hundimiento craneal congénita: una realidad obstétrica

“…Su diagnóstico suele ser mediante la exploración física en el momento del nacimiento, generando una gran alarma por la hipotética mala atención obstétri-ca del parto, con las consiguientes responsabilidades médico-legales, a pesar, que no a podido relacionarse su aparición con trauma obstétrico (3). Presentamos el diagnóstico de dos neonatos con fractura-hundimiento del parietal derecho intrauterino, descripción radiológica y manejo, así como evolución clínica posterior.…”