Top

Published in:

Open Access 19-01-2024 | Neonatal Birth Trauma | Research

Neonatal upper limb fractures – a narrative overview of the literature

Authors: Marcos Carvalho, Maria Inês Barreto, João Cabral, Inês Balacó, Cristina Alves

Published in: BMC Pediatrics | Issue 1/2024

Abstract

The aim of this paper is to review the topic of neonatal fractures of the upper limb, describing the different types of fractures focusing on the etiology, epidemiology, risk factors, clinical approach, diagnosis, treatment and prognosis of these injuries. We included all types of research studies, both experimental and observational, published in English, French, Portuguese and Spanish. The information was obtained using the keywords neonatal upper limb fracture, clavicle fracture or humerus fracture from the following resources: MEDLINE database, Embase^® database and LILACS database. Other resources such as hand searches of the references of retrieved literature and authoritative texts, personal and hospital libraries searching for texts on upper limb neonatal fractures, discussions with experts in the field of upper limb neonatal fractures and personal experience, were also considered for the completion of the article.

Neonatal fractures of the upper limb are consensually considered to have a good prognosis and no long-term sequelae. Conservative treatment is the option in the vast majority of the fractures and is associated with excellent results, with good healing, full range of motion, adequate remodeling without obvious deformity, neurologic impairment or functional implications.

Pressler JL. Classification of major newborn birth injuries. J Perinat Neonatal Nurs. 2008;22(1):60–7.PubMedCrossRef

Phuengphaeng A, Sirisomboon R. Incidence and Risk Factors of Major Neonatal Birth Injuries in a Tertiary Care Hospital in Thailand: A Retrospective Cohort Study. PRIJNR. 2022;26(2):243–5.

Iskender C, Kaymak O, Erkenekli K, et al. Neonatal injury at cephalic vaginal delivery: a retrospective analysis of extent of association with shoulder dystocia. PLoS One. 2014;9(8):e104765. https://doi.org/10.1371/journal.pone.0104765. (Published 2014 Aug 21).CrossRefPubMedPubMedCentral

Clapp MA, Bsat J, Little SE, Zera CA, Smith NA, Robinson JN. Relationship between parity and brachial plexus injuries. J Perinatol. 2016;36(5):357–61. https://doi.org/10.1038/jp.2015.205.CrossRefPubMed

Linder N, Linder I, Fridman E, Kouadio F, Lubin D, Merlob P, et al. Birth trauma-isk factors and short-term neonatal outcome. J Matern Fetal Neonatal Med. 2013;26(15):1491–5. https://doi.org/10.3109/14767058.2013.789850.CrossRefPubMed

Ouzounian JG. Risk factors for neonatal brachial plexus palsy. Semin Perinatol. 2014;38(4):219–21. https://doi.org/10.1053/j.semperi.2014.04.008.CrossRefPubMed

Ojumah N, Ramdhan RC, Wilson C, Loukas M, Oskouian RJ, Tubbs RS. Neurological neonatal birth injuries: a literature review. Cureus. 2017;9(12):e1938. https://doi.org/10.7759/cureus.1938.CrossRefPubMedPubMedCentral

Karahanoglu E, Kasapoglu T, Ozdemirci S, Fadiloglu E, Akyol A, Demirdag E, et al. Risk factors for clavicle fracture concurrent with brachial plexus injury. Arch Gynecol Obstet. 2016;293(4):783–7. https://doi.org/10.1007/s00404-015-3917-5.CrossRefPubMed

Ahn ES, Jung MS, Lee YK, Ko SY, Shin SM, Hahn MH. Neonatal clavicular fracture: recent 10 year study. Pediatr Int. 2015;57(1):60–3.PubMedCrossRef

10.

Högberg U, Fellman V, Thiblin I, Karlsson R, Wester K. Difficult birth is the main contributor to birth-related fracture and accidents to other neonatal fractures. Acta Paediatr. 2020;109(10):2040–8. https://doi.org/10.1111/apa.15217.CrossRefPubMed

11.

Kekki M, Salonen A, Koukkula T, Laivuori H, Tihtonen K, Huttunen TT. Incidence changes in risk factors associated with the decreasing number of birth-related clavicle fractures in Finland: A nationwide retrospective birth cohort from 2004 to 2017 [published online ahead of print, 2022 Jun 23]. Birth. 2022;https://doi.org/10.1111/birt.12662. doi:https://doi.org/10.1111/birt.12662

12.

Sauber-Schatz EK, Markovica N, Weissa HB, Bodnara LM, Wilson JW, Pearlman MD. Descriptive epidemiology of birth trauma in United States in 2003. Paediatr Perinat Epidemiol. 2010;24:116–24.PubMedCrossRef

13.

Choi HA, Lee YK, Ko SY, Shin SM. Neonatal clavicle fracture in cesarean delivery: incidence and risk factors. J Matern Fetal Neonatal Med. 2017;30(14):1689–92.PubMedCrossRef

14.

Beall MH, Ross MG. Clavicle fracture in labor: risk factors and associated morbidities. J Perinatol. 2001;21:513–5.PubMedCrossRef

15.

Ashwal E, Berezowsku A, Orbach-Zinger S, et al. Birthweight thresholds for increased risk for maternal and neonatal morbidity following vaginal delivery: a retrospective study. Arch Gynecol Obstet. 2018;298:1123–9.PubMedCrossRef

16.

Gudmundsson S, Henningsson A, Lindqvist P. Correlation of birth injury with maternal height and birthweight. BJOG. 2005;112:764–7.PubMedCrossRef

17.

Aubry EM, Oelhafen S, Fankhauser N, Raio L, Cignacco EL. Adverse perinatal outcomes for obese women are infuenced by the presence of comorbid diabetes and hypertensive disorders. Sci Rep. 2019;9(1):9793. https://doi.org/10.1038/s41598-019-46179-8.CrossRefPubMedPubMedCentral

18.

Madsen S, Wand S, Golan A, Sadan O. Risk factors for fractured clavicle in the newborn. J Obstet Gynaecol. 2011;37(11):1572–4.CrossRef

19.

Basha A, Amarin Z, Abu-Hassan F. Birth-associated long-bone fractures. Int J Gynaecol Obstet. 2013;123(2):127–30. https://doi.org/10.1016/j.ijgo.2013.05.013.CrossRefPubMed

20.

Amir J, Katz K, Grunebaum M, Yosipovich Z, Wielunsky E, Reisner SH. Fractures in premature infants. J Pediatr Orthop. 1988;8:41–4.PubMedCrossRef

21.

Morris S, Cassidy N, Stephens M, McCormack D, McManus F. Birth-associated femoral fractures: incidence and outcome. J Pediatr Orthop. 2002;22:27–30.PubMedCrossRef

22.

Sherr-Lurie N, Bialik GM, Ganel A, Schindler A, Givon U. Fractures of the humerus in the neonatal period. Isr Med Assoc J. 2011;13:363–5.PubMed

23.

Kancherla R, Sankineani SR, Naranje S, Rijal L, Kumar R, Ansari T, Trikha V. Birth-related femoral fracture in newborns: risk factors and management. J Child Orthop. 2012;6:177–80.PubMedPubMedCentralCrossRef

24.

Cumming WA. Neonatal skeletal fractures. Birth trauma or child abuse? JCan Assoc Radiol. 1979;30:30–3.

25.

Von Heideken J, Thiblin I, Högberg U. The epidemiology of infant shaft fractures of femur or humerus by incidence, birth, accidents, and other causes. BMC Musculoskelet Disord. 2020;21(1):840. https://doi.org/10.1186/s12891-020-03856-4. (Published 2020 Dec 11).CrossRef

26.

Hsu TY, Hung FC, Lu YJ, et al. Neonatal clavicular fracture: clinical analysis of incidence, predisposing factors, diagnosis, and outcome. Am J Perinatol. 2002;19:17.PubMedCrossRef

27.

Lam MH, Wong GY, Lao TT. Reappraisal of neonatal clavicular fracture: relationship between infantsize and neonatal morbidity. Obstet Gynecol. 2002;100:115.PubMed

28.

Caviglia H, Garrido CP, Palazzi FF, Meana NV. Pediatric fractures of the humerus. Clin Orthop RelatRes. 2005;432:49.CrossRef

29.

Nadas S, Gudinchet F, Capasso P, Reinberg O. Predisposing factors in obstetrical fractures. SkeletalRadiol. 1993;22:195.

30.

Thompson KA, Satin AJ, Gherman RB. Spiral fracture of the radius: an unusual case of shoulderdystocia-associated morbidity. Obstet Gynecol. 2003;102:36.PubMed

31.

Akangire G, Carter B. Birth injuries in neonates. Pediatr Rev. 2016;37(11):451–62.PubMedCrossRef

32.

Rehm A, Promod P, Ogilvy-Stuart A. Neonatal birth fractures: a retrospective tertiary maternity hospital review. J Obstet Gynaecol. 2020;40(4):485–90.PubMedCrossRef

33.

Wei C, Stevens J, Harrison S, Mott A, Warner J. Fractures in a tertiary Neonatal Intensive Care Unit in Wales. Acta Paediatr. 2012;101(6):587–90.PubMedCrossRef

34.

Williams BA, Makarewich CA, Montoya-Williams DC, Krakow A, Lioy J, Horn BD. Epidemiology and management of appendicular fractures occurring in neonatal intensive care patients. Acta Paediatr. 2021;110(2):489–94.PubMedCrossRef

35.

Rauch F, Schoenau E. Skeletal development in premature infants: a review of bone physiology beyond nutritional aspects. Arch Dis Child Fetal Neonatal Ed. 2002;86:F82-5.PubMedPubMedCentralCrossRef

36.

Rustico SE, Calabria AC, Garber SJ. Metabolic bone disease of prematurity. J Clin Transl Endocrinol. 2014;1(3):85–91.PubMedPubMedCentral

37.

Chinoy A, Mughal MZ, Padidela R. Metabolic bone disease of prematurity: causes, recognition, prevention, treatment and long-term consequences. Arch Dis Child Fetal Neonatal Ed. 2019;104(5):F560–6.PubMedCrossRef

38.

Kaushal S, Raisingani M, David R, Shah B. Spiral fracture in Young infant causing a diagnostic dilemma: nutritional rickets versus child abuse. Case Rep Pediatr. 2017;2017:7213629.PubMedPubMedCentral

39.

Albertini F, Marquant E, Reynaud R, Lacroze V. Two cases of fractures in neonates associated with maternofetal vitamin D deficiency. Arch Pediatr. 2019;26:361–4.PubMedCrossRef

40.

Miller M, Stolfi A, Ayoub D. Findings of metabolic bone disease in infants with unexplained fractures in contested child abuse investigations: a case series of 75 infants. J Pediatr Endocrinol Metab. 2019;32:1103–20.PubMedCrossRef

41.

Högberg U, Winbo J, Fellman V. Population-based register study of children born in Sweden from 1997 to 2014 showed an increase in rickets during infancy. Acta Paediatr. 2019;108:2034–40.PubMedCrossRef

42.

Kekki M, Salonen A, Tihtonen K, Mattila VM, Gissler M, Huttunen TT. The incidence of birth injuries decreased in Finland between 1997 and 2017: a nationwide register study. Acta Paediatr. 2020;109(12):2562–9.PubMedCrossRef

43.

Gandhi AR, Christopher JD, Apurva SS. The association of clavicle fracture with brachial plexus birth palsy. Journal of Hand Surgery. 2019;44(6):467–72.PubMedCrossRef

44.

Bhat BV, Kumar A. Oumachigui Asherr. Indian J Pediatr. 1994;61:401.PubMedCrossRef

45.

Madsen ET. Fractures of the extremities in the newborn. Acta Obstet Gynecol Scand. 1955;34(1):41–74.PubMedCrossRef

46.

Persson M, Norman M, Hanson U. Obstetric and fetal outcomes in type 1 diabetic pregnancies—a large, population-based study. Diabetes Care. 2009;32:1–2.CrossRef

47.

Sentilhes L, Sénat MV, Boulogne AI, et al. Shoulder dystocia: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol. 2016;203:156–61.PubMedCrossRef

48.

Poston L, Caleyachetty R, Cnattingius S, et al. Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol. 2016;4:1025–36.PubMedCrossRef

49.

50.

Yenigül AE, Yenigül NN, Başer E, Özelçi R. A retrospective analysis of risk factors for clavicle fractures in newborns with shoulder dystocia and brachial plexus injury: a single-center experience. Acta Orthop Traumatol Turc. 2020;54(6):609–13.PubMedPubMedCentralCrossRef

51.

Macrosomia. ACOG practice bulletin no. 216. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2020;135:e18-e35.

52.

Metzger BE, Lowe LP, Dyer AR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.PubMedCrossRef

53.

Poolsup N, Suksomboon N, Amin M. Effect of treatment of gestational diabetes mellitus: a systematic review and meta-analysis. PLoS One. 2014;9(3):e92485. https://doi.org/10.1371/journal.pone.0092485.CrossRefPubMedPubMedCentral

54.

Michelotti F, Flatley C, Kumar S. Impact of shoulder dystocia, stratified by type of manoeuvre, on severe neonatal outcome and maternal morbidity. Aust N Z J Obstet Gynaecol. 2018;58:298–305.PubMedCrossRef

55.

Van der Looven R, Le Roy L, Tanghe E, Samijn B, Roets E, Pauwels N, Deschepper E, De Muynck M, Vingerhoets G, Van den Broeck C. Risk factorsfor neonatal brachial plexus palsy: a systematic review and meta-analysis. Dev Med Child Neurol. 2020;62:673–83.PubMedCrossRef

56.

Al-Rajeh S, Corea JR, Al-Sibai MH, Al-Umran K, Sankarankutty M. Congenital brachial palsy in the eastern province of Saudi Arabia. J Child Neurol. 1990;5(1):35–8.PubMedCrossRef

57.

Evans-Jones G, Kay SP, Weindling AM, Cranny G, Ward A, Bradshaw A, Hernon C. Congenital brachial palsy: incidence, causes, and outcome in the United Kingdom and Republic of Ireland. Arch Dis Child Fetal Neonatal Ed. 2003;88:F185-9.PubMedPubMedCentralCrossRef

58.

Kaya B, Daglar K, Kirbas A, Tüten A. Humerus Diaphysis Fracture in a Newborn during Vaginal Breech Delivery. Case Rep Obstet Gynecol. 2015;2015:489108. https://doi.org/10.1155/2015/489108.CrossRefPubMedPubMedCentral

59.

Jacobsen S, Hansson G, Nathorst-Westfelt J. Traumatic separation of the distal epiphysis of the humerus sustained at birth. J Bone Joint Surg. 2009;91-B:797–802.CrossRef

60.

Oppenheim WL, Davis A, Growdon WA, et al. Clavicle fractures in the newborn. Clin Orthop RelatRes. 1990;250:176.

61.

Husain SN, King EC, Young JL, et al. Remodeling of birth fractures of the sherrhumeral diaphysis. J Pediatr Orthop. 2008;28(1):10–3.PubMedCrossRef

62.

Mahapatra SK, Jangira V, Kalra M. Neonatal radial nerve palsy associated with humerus fracture: is the fracture to be blamed? Orthop Surg. 2014;6(2):162–4.PubMedPubMedCentralCrossRef

63.

Alsubhi FS, Althunyan AM, Curtis CG, Clarke HM. Radial nerve palsy in the newborn: a case series. CMAJ. 2011;183(12):1367–70.PubMedPubMedCentralCrossRef

64.

Senes FM, Campus R, Becchetti F, Catena N. Upper limb nerve injuries in developmental age. Microsurgery. 2009;29(7):529–35.PubMedCrossRef

65.

Kay M, Simpkins C, Shipman P, Whitewood C. Diagnosing neonatal transphyseal fractures of the distal humerus. J Med Imaging Radiat Oncol. 2017;61(4):494–9. https://doi.org/10.1111/1754-9485.12607.CrossRefPubMed

66.

Astedt B. A method for the treatment of humerus fractures in the newborn using the S. Von Rozen splint Acta Orthop Scand. 1969;40:234–6.CrossRef

67.

Rogers LF, Rockwood CA Jr. Separation of the entire distal humeral epiphysis. Radiology. 1973;106:393–400.PubMedCrossRef

68.

Abzug JM, Ho CA, Ritzman TF, Brighton BK. Transphyseal Fracture of the Distal Humerus. J Am Acad Orthop Surg. 2016;24(2):e39–44.PubMedCrossRef

69.

Howard CB, Shinwell E, Nyska M, Meller I. Ultrasound diagnosis of neonatal fracture separation of the upper humeral epiphysis. J Bone Joint Surg British. 1992;74:471–2.CrossRef

70.

Brown J, Eustace S. Neonatal transphyseal supracondylar fracture detected by ultrasound. Pediatr Emerg Care. 1997;13:410–2.PubMedCrossRef

71.

Dias JJ, Lamont AC, Jones JM. Ultrasonic diagnosis of neonatal separation of the distal humeral epiphysis. J Bone Joint Surg Br. 1988;70:825–8.PubMedCrossRef

72.

Ziv N, Litwin A, Katz K, Merlob P, Grunebaum M. Definitive diagnosis of fracture-separation of the distal humeral epiphysis in neonates by ultrasonography. Pediatr Radiol. 1996;26:493–6.PubMedCrossRef

73.

Costa M, Owen-Johnstone S, Tucker JK, Marshall T. The value of MRI in the assessment of an elbow injury in a neonate. J Bone Joint Surg British. 2001;83:544–6.CrossRef

74.

Bayne O, Rang M. Medial dislocation of the radial head following breech delivery: a case report and review of the literature. J Pediatr Orthop. 1984;4:485–7.PubMedCrossRef

75.

Catena N, Sénès FM. Obstetrical chondro-epiphyseal separation of the distal humerus: a case report and review of literature. J Perinat Med. 2009;37(4):418–9.PubMedCrossRef

76.

Gigante C, Kini SG, Origo C, Volpin A. Transphyseal separation of the distal humerus in newborns. Chin J Traumatol. 2017;20(3):183–6.PubMedPubMedCentralCrossRef

77.

Arrigoni C, Sini D, Origo C. Use of arthrography in managing neonatal epiphyseal distal humerus separation. Minerva Orthopedics. 2022;73(5):487–92.CrossRef

78.

Liu J, Zhang L, Qiu RX. Ultrasound Instead of X-Ray to Diagnose Neonatal Fractures: A Feasibility Study Based on a Case Series. Front Pediatr. 2022;10:847776.PubMedPubMedCentralCrossRef

79.

Sabat D, Maini L, Gautam VK. Neonatal separation of distal humeral epiphysis during Caesarean section: a case report. J Orthop Surg (Hong Kong). 2011;19:376–8.PubMedCrossRef

80.

Navallas M, Díaz-Ledo F, Ares J, Sánchez- Buenavida A, López-Vilchez MA, Solano A, García García J, Maiques JM, Mur-Sierra A, Alier A. Distal humeral epiphysiolysis in the newborn: utility of sonography and differential diagnosis. Clin Imaging. 2013;37:180–4.PubMedCrossRef

81.

Söyüncü Y, Cevikol C, Söyüncü S, Yildirim A, Akyildiz F. Detection and treatment of traumatic separation of the distal humeral epiphysis in a neonate: a case report. Ulus Travma Acil Cerrahi Derg. 2009;15:99–102.PubMed

82.

Kamaci S, Danisman M, Marangoz S. Neonatal physeal separation of distal humerus during cesarean section. Am J Orthop (Belle Mead NJ). 2014;43(11):E279–81.PubMed

83.

Lin RL, Liu ZJ, Zhang LJ. Neonatal distal humeral physeal separation during cesarean section: a case report and review of a literature. Int J Clin Exp Med. 2016;9(3):6882–9.

84.

Tharakan SJ, Lee RJ, White AM, Lawrence JT. Distal Humeral Epiphyseal Separation in a Newborn. Orthopedics. 2016;39(4):e764–7.PubMedCrossRef

85.

Tan W, Wang FH, Yao JH, Wu WP, Li YB, Ji YL, Qian YP. Percutaneous fixation of neonatal humeral physeal fracture: A case report and review of the literature. World J Clin Cases. 2020;8(19):4535–43.PubMedPubMedCentralCrossRef

86.

Galeotti A, Zanardi A, Giacinto SD, Beltrami G, Cucca G, Lazzeri S. Transphyseal distal humeral separation in neonates: A case series [published online ahead of print, 2023 Mar 16]. Injury. 2023;S0020–1383(23):00263–2. https://doi.org/10.1016/j.injury.2023.03.016.CrossRef

87.

Hariharan AR, Ho C, Bauer A, et al. Transphyseal Humeral Separations: What Can We Learn? A Retrospective, Multicenter Review of Surgically Treated Patients Over a 25-Year Period. J Pediatr Orthop. 2020;40(6):e424–9.PubMedCrossRef

88.

Shrader MW. Proximal humerus and humeral shaft fractures in children. Hand Clin. 2007;23(4):431–5.PubMedCrossRef

89.

Ratti C, Guindani N, Riva G, Callegari L, Grassi FA, Murena L. Transphyseal elbow fracture in newborn: review of literature. Musculoskelet Surg. 2015;99(Suppl 1):S99–105.PubMedCrossRef

90.

Tudisco C, Mancini F, De Maio F, Ippolito E. Fracture-separation of the distal humeral epiphysis. Long-term follow-up of five cases. Injury. 2006;37(9):843–8.PubMedCrossRef

91.

Patil MN, Palled E. Epihyseal Separation of Lower end Humerus in A Neonate- Diagnostic and Management Difficulty. J Orthop Case Rep. 2015;5(4):7–9.PubMedPubMedCentral

92.

Shrader MW. Proximal humerus and humeral shaft fractures in children. Hand Clin. 2007;23(4):431–5.PubMedCrossRef

93.

Ratti C, Guindani N, Riva G, Callegari L, Grassi FA, Murena L. Transphyseal elbow fracture in newborn: review of literature. Musculoskelet Surg. 2015;99(Suppl 1):S99–105.PubMedCrossRef

94.

Tudisco C, Mancini F, De Maio F, Ippolito E. Fracture-separation of the distal humeral epiphysis. Long-term follow-up of five cases. Injury. 2006;37(9):843–8.PubMedCrossRef

Title: Neonatal upper limb fractures – a narrative overview of the literature
Authors: Marcos Carvalho
Maria Inês Barreto
João Cabral
Inês Balacó
Cristina Alves
Publication date: 19-01-2024
Publisher: BioMed Central
Keywords: Neonatal Birth Trauma
Shoulder Girdle and Upper Arm Injuries
Pediatric Trauma and Orthopedics
Clavicle Fracture
Infantile Humerus Fracture
Fracture Healing
Pediatric Diagnostics
Published in: BMC Pediatrics / Issue 1/2024
Electronic ISSN: 1471-2431
DOI: https://doi.org/10.1186/s12887-024-04538-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Neonatal upper limb fractures – a narrative overview of the literature

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2024

Multisystem inflammatory syndrome in children (MIS-C) post-COVID-19 in Iran: clinical profile, cardiac features, and outcomes

Predicting factors for acute encephalopathy in febrile seizure children with SARS-CoV-2 omicron variant: a retrospective study

Tic disorder in allergic rhinitis children and adolescents: a case-control study

Which training load indicators are greater correlated with maturation and wellness variables in elite U14 soccer players?

Non-pharmacological interventions for delirium in the pediatric population: a systematic review with narrative synthesis

Identification of a novel GNAS mutation in a family with pseudohypoparathyroidism type 1A