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

Basaldella, Luca; Marton, Elisabetta; Bekelis, Kimon; Longatti, Pierluigi

doi:10.1177/0883073811410058

Cited by 16 publications

(9 citation statements)

References 16 publications

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“…La localización de estas fracturas es más frecuente en el hueso frontal (65 %), seguido por el hueso parietal (28 %). 5 F r e n t e a p a c i e n t e s c o n f r a c t u r a c o n h u n d i m i e n t o d e c r á n e o i n t r a u t e r i n a , s e recomienda realizar radiografía y tomografía computada de cráneo, con el objetivo de evaluar la presencia de lesiones asociadas, como hematoma epidural o subdural y daño parenquimatoso, y la presencia de fragmentos óseos. 3 En cuanto al pronóstico y a la evolución, las formas espontáneas suelen ser benignas y no se asocian a daño neurológico.…”

Section: Discussionunclassified

“…Algunos autores recomiendan seguimiento clínico; de hecho, se han reportado casos de resolución espontánea de la lesión. [5][6][7] Una conducta alternativa favorece la corrección quirúrgica, 1,2,8 cuyas indicaciones son lesiones asociadas a la fractura (presencia de hemorragia encefálica, contusión cerebral o fragmentos óseos), signos de foco neurológico asociado a la fractura, hipertensión endocraneal, gran defecto estético o lesiones de gran tamaño (más de 5 mm de profundidad y/o más de 2 cm de largo) por el riesgo de compresión cerebral y aparición de convulsiones. 9 En ausencia de estas indicaciones, hay autores que recomiendan esperar desde días hasta meses luego del diagnóstico a fin de realizar la corrección quirúrgica.…”

Section: Discussionunclassified

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Fractura con hundimiento de cráneo intrauterina espontánea: reporte de dos casos

2022

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Reporte de casos RESUMENLas fracturas con hundimiento de cráneo intrauterinas representan una entidad poco frecuente, generalmente secundaria a traumatismos (previos o durante el nacimiento) o de etiología desconocida. Suelen requerir evaluación y seguimiento por el servicio de Neurocirugía Pediátrica. A la fecha, es controversial la necesidad de tratamiento quirúrgico y el momento oportuno para concretarlo. Se presentan dos casos clínicos de pacientes de término, nacidas por cesárea, con diagnóstico posnatal inmediato de hundimiento de cráneo de tipo ping-pong no traumático. Ambas pacientes presentaron examen neurológico normal. Se confirmó el diagnóstico a través de radiografía y tomografía de cráneo, sin observarse lesiones asociadas. Fueron valoradas por el servicio de Neurocirugía, que indicó corrección quirúrgica de la lesión en ambos casos, con buena evolución posterior.

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Section: Discussionunclassified

Fractura con hundimiento de cráneo intrauterina espontánea: reporte de dos casos

2022

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“…Basaldella et al 2 reported two cases of spontaneous intrauterine ping-pong fractures following caesarean section that resolved spontaneous within 8 months. Hanlon et al 16 presented a neonatal case with right parietal skull depression due to vacuum extraction during labour that improved spontaneously within 4 months.…”

Section: Discussionmentioning

confidence: 99%

“…Ping-pong fractures in newborns are rare, with an estimated occurrence of 1–2.5 cases per 10 000 live births. They develop in two distinct forms: iatrogenic or spontaneous 2. Treatment options are controversial and include either non-surgical elevation or direct operative techniques, or spontaneous elevation over time 1.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous resolution of a ‘ping-pong’ fracture at birth

İlhan¹,

Bor

Yukkaldiran

2018

BMJ Case Reports

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‘Ping-pong’ fractures are depressed skull fractures in newborn infants that occur as inward buckling of the calvarial bones, forming a cup shape. These fractures are often associated with maintenance of bone continuity. These fractures may occur spontaneously during the intrauterine period or secondary to birth trauma. Currently, there is no standard protocol for the management of depressed skull fractures. Neurosurgical or non-surgical approaches may be administered depends on the severity of the fracture. Most untreated ping-pong fractures resolve spontaneously within 6 months. Therefore, it is recommended to reserve surgical elevation or non-surgical techniques for infants not demonstrating spontaneous resolution during this period. In addition, neurosurgical interventions are usually considered for cases with intracranial pathology or neurological deficits or for infants who do not respond to conservative treatment. Herein, we report a case of a newborn infant with a spontaneous intrauterine ping-pong fracture, which spontaneously resolved, without surgical or non-surgical intervention.

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“…In these circumstances, surgical correction may be achieved through a small craniotomy or by creating an adjacent burr hole and elevating the fracture with a Penfield dissector. 5,6 Reports of nonsurgical elevation through use of various suction devices date back to the 1970s and describe techniques using obstetric suction tools, breast pumps, and wall suction with variable levels of success. 7-9 To our knowledge, this article is the first to report successful elevation of PPF using a hospital-grade breast pump and a customized mold made with materials widely available in any hospital.…”

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confidence: 99%

Elevation of Depressed Skull Fracture in Neonates Using a Breast Pump and a Custom-Molded Flange

Martinez,

Welscher,

Shah

et al. 2024

Operative Neurosurgery

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BACKGROUND AND IMPORTANCE: “Ping-pong fractures” (PPF) can occur in neonates and result in cosmetic deformity and local mass effect. Standard treatment involves surgical elevation of the depressed bone when the indentation is considerable or cosmetically apparent. Surgical correction of PPF subjects patients to the risks of surgery and general anesthesia. This article and corresponding video demonstrate a novel means of correcting PPF at bedside without surgery or anesthesia. We used a hospital-grade breast pump connected to a custom-fabricated flange to successfully elevate PPF in two neonates. CLINICAL PRESENTATION: Two moderately preterm infants were noted at birth to have large parietal PPF. To avoid surgical intervention, elevation using a suction device was attempted. A hospital-grade breast pump was used to provide suction. A custom device was fabricated out of a breast pump flange and molded Coloplast Brava® protective seal rings. This device was carefully applied to the skull to exactly match the diameter of the PPF and contour of the bone. Brief (15-30 seconds) periods of suction were applied several times until the PPF was successfully elevated as documented on subsequent computed tomography scans. Both infants achieved excellent cosmetic results with no adverse effects over 24- and 9-month follow-ups, respectively. DISCUSSION: This technique eliminates the risks of open surgical correction and corrected the PPF without general anesthesia or adverse effects to the infant. While there may be limitations due to patient age and/or location of the PPF, the use of widely available and inexpensive custom-fitted materials with a hospital grade breast pump achieves maximal efficacy without requiring higher negative pressure suction application. CONCLUSION: Elevation of PPF can be safely achieved in some neonates using readily available equipment: a hospital-grade breast pump, flange, and moldable adherent material. This technique is reasonable to attempt in lieu of surgical elevation.

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

Cited by 16 publications

References 16 publications

Fractura con hundimiento de cráneo intrauterina espontánea: reporte de dos casos

Fractura con hundimiento de cráneo intrauterina espontánea: reporte de dos casos

Spontaneous resolution of a ‘ping-pong’ fracture at birth

Elevation of Depressed Skull Fracture in Neonates Using a Breast Pump and a Custom-Molded Flange

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