Obstetrics and Gynecology - A.M. Gromova 2000

Neonatal Diseases
Birth Injuries of the Newborn
Birth Trauma to the Bones

Clavicle fracture is one of the most common Birth injuries, with an incidence ranging from 1% to 2%.

The primary cause is fetopelvic disproportion between the size of the maternal pelvis and the shoulder girdle of a macrosomic fetus. Clavicle fractures often occur during precipitous labor when the fetal shoulder girdle fails to rotate adequately and is delivered through the narrower transverse diameter of the pelvic outlet. Another common cause is improper obstetric manual assistance, such as premature delivery of the posterior shoulder or excessive downward pressure of the anterior shoulder against the maternal Pubic Symphysis. Fractures of the right clavicle are more frequent because vertex presentations most commonly occur in the left occipitoanterior position.

Diagnosis is relatively straightforward: crepitus and restricted limb mobility are observed in the fracture area. Treatment involves applying a stabilizing bandage to the infant's shoulder girdle and arm. A small roll is placed under the armpit to abduct the arm from the chest wall, while the forearm is flexed at the elbow and brought across the chest. Bone healing occurs by days 7–8, and active arm movement is fully restored by the end of the second week.

Humeral fractures occur in approximately 1 per 2,000 deliveries. They typically result from difficulties in delivering the fetal arms during obstetric maneuvers in breech presentations. These fractures most frequently occur in the middle third of the humerus and are accompanied by minimal fragment displacement.

Diagnosis is established based on local bone crepitus and Swelling caused by a hematoma. Treatment consists of immobilizing the arm alongside the torso or applying a shoulder splint. The fracture typically heals within 2 to 3 weeks.

Fractures of the Femur and lower leg bones occur in newborns at a rate of 1 per 4,000 deliveries. They may occur during total Breech Extraction or when extracting the fetus by the FOOT during a Cesarean Section.

Femoral fractures are most commonly located in the middle third of the bone and are identified by leg shortening caused by marked Muscle retraction, soft tissue swelling, and the infant's pain response.

The diagnosis is confirmed by X-ray Examination. Limb immobilization using a splint is required, and skeletal traction is indicated in cases of displaced bone fragments. Callus formation occurs by the third week of life, and complete healing is achieved by the fourth week.