BIRTH FRACTURES

BIRTH FRACTURES : 

BIRTH FRACTURES AMALA INSTITUTE OF MEDICAL SCIENCES

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Common in breech deliveries Reparative powers very good- usually remodels into perfect position 3 types of # in newborn 1) # or epiphyseal displacement sustained during difficult delivery 2) multiple # associated with congenital fragility of bone 3) congenital pseudoarthrosis of tibia

# shaft of humerus : 

# shaft of humerus # middle third of shaft of humerus Breech deliveries- attempts to extract extended arms Deliver impacted shoulders in vertex presentation # is transverse or spiral Outward angulation- pull of deltoid on proximal fragment Radial nerve palsy- recovers in 6- 8 weeks Callus formation- firm union in 3 weeks

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DIAGNOSIS Dangling arm, failure to move Confirmed by radiological and clinical examination TREATMENT Arm strapped to chest- maintain moderate abduction May unite with some outward angulation- will be corrected

# of shaft of clavicle : 

# of shaft of clavicle Usually middle of shaft Direct digital pressure on bone during traction to shoulders- delivery of aftercoming head Both clavicles may # simultaneously DIAGNOSIS usually unnoticed until callus formation displacement of fragments as in adult

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TREATMENT no treatment required do not pull on the arms for first 2- 3 weeks CONGENITAL PSEUDOARTHROSIS OF CLAVICLE Rare condition- Fitzwilliam 1910 Abnormal ossification rather than trauma Right clavicle is affected in all cases Swelling seen after birth, pseudoarthrosis situated lateral to mid-shaft of bone, painless mobility Treatment- excision with bone grafting and intramedullary fixation between 5 and 8 years

# shaft of femur : 

# shaft of femur Torsion on presenting leg in breech deliveries, delivery of breech with extended legs During extraction by caesarean section Psoas muscle contraction- proximal half of femur strongly flexed at right angles to distal half TREATMENT Thomas splint or wooden spica- shortening, forward angulation limb bandaged to front of infant’s body with hip fully flexed- often used but deformity overcorrected, backward angulation, shortening

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Most rational method- birth fracture frame Limb at right angles to the trunk- exactly in the axis in which proximal fragment is held by psoas muscle Overhead suspension of both lower limbs Base- bound firmly with bandage 2 notches on cross bar- extension strappings Sufficient tension to raise the buttocks

Depressed # of skull : 

Depressed # of skull Pliability of skull, wide open cranial sutures- protect Even in severe intracranial birth injuries # unusual Parietal bones involved- pressure of head on bones of pelvic inlet, especially promontory Spontaneous elevation- very occasionally depression and furrow persist

EPIPHYSEAL DISPLACEMENTS : 

EPIPHYSEAL DISPLACEMENTS LOWER FEMORAL EPIPHYSIS Clinical diagnosis- helplessness and immobility of limb, pain and swelling Centre of ossification present at birth- radiograhic diagnosis easy Treatment- immobilise on spatula splint or birth # frame 3 wks

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LOWER HUMERAL EPIPHYSIS Clinical diagnosis Centre of ossification of lower humeral epiphysis does not appear until later half of first year Radiographic diagnosis difficult initially- displacement of radius in relation to line of humerus muffled crepitus during reduction Treatment- traction, elbow supported in collar and cuff

# associated with congenital fragility of bones : 

# associated with congenital fragility of bones OSTEOGENESIS IMPERFECTA Fragilitas ossium Frequent #, weak and brittle bones Defective collagen synthesis Commonly AD, severe AR variant Associated blue sclera, joint lakity and osteosclerosis in adulthood Severe disease- live few years Deformities secondary to malunion and contractures

Congenital pseudoarthrosis of tibia : 

Congenital pseudoarthrosis of tibia Characterised by minimal callus formation and non- union which persists despite prolonged immobilisation and bone grafting operations 3 clinical types 1) associated with neurofibromatosis 2) associated with fibrous dysplasia 3) associated with anterior bowing of the tibia

REFERENCES : 

REFERENCES Essential Orthopaedics- J. Maheshwari, 3rd edition

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Thankyou!