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Fractures at Birth - Causes, Symptoms, Diagnosis, and Treatment

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Fractures of newborns occur due to injury during the birth process. Read the article to know more about fractures at birth.

Medically reviewed by

Dr. Suman Saurabh

Published At January 12, 2023
Reviewed AtDecember 1, 2023

Introduction:

Birth injury is a kind of impairment in the baby’s body structure and function due to adverse events during delivery. Birth injuries should not be confused with congenital disabilities. They both are two different entities. However, technological advancements have declined the birth trauma rate over the last few years.

What Are the Risk Factors Associated With Birth Trauma?

Fetal and pregnancy-related factors are the weight of the fetus greater than 4000 g, macrocephaly, prematurity, and congenital anomalies in the fetus.

Maternal Factors are maternal diabetes, obesity, small maternal stature, use of forceps or vacuum, and prolonged or rapid labor.

What Are the Sites Affected by Birth Trauma?

The common sites affected during labor are the head, neck, and shoulders. The less common areas are the abdomen, face, and lower limbs.

What Are the Injuries That Occur During Birth?

  • Head trauma includes superficial lesions, intracranial and extracranial hemorrhages, and skull fractures.

  • Cranial nerve injury affects the facial nerve significantly.

  • Peripheral nerve and spinal cord injuries can occur.

  • Skeletal injuries involve the fracture of the clavicle, femoral, and humerus bones.

  • Facial injuries primarily affect the eyes.

  • Soft tissue injuries.

  • Visceral injuries.

How Are the Bones in a Fetus?

The bone formation will be in progress when the baby is delivered. Initially, babies have 275 bones that fuse to form 206 bones later in adulthood.

What Are the Fractures Commonly Noticed at Birth?

How Many Bones Does a Newborn Skull Have?

The skull of newborns have

  • Two frontal bones.

  • One occipital bone.

  • Two parietal bones.

These bones are joined together by sutures, and the skull is flexible enough to emerge from the birth canal.

What Are the Causes of Skull Fractures?

  • Using instruments such as forceps and vacuum extractors as labor becomes difficult.

  • The unusually large size of the baby makes the delivery difficult.

  • Excessive pressure is applied to the baby’s head during delivery.

  • Sometimes the skull gets fractured just due to the pressure on the head when coming out of the womb.

What Are the Types of Skull Fractures?

  • Linear Skull Fractures: It is a crack between the bones without mobility. They are not too severe, but bleeding below the fracture line may be noticed.

  • Depressed Skull Fractures: This is a more serious fracture where the skull sinks inwards and causes excessive bleeding and pressure on the brain.

  • Diastatic Skull Fractures: This type of fracture occurs along the suture line. This damages the baby as it ages and expands as the brain grows.

What Are the Symptoms of Skull Fractures?

  • Linear fractures often get unnoticed and heal by themselves.

  • The depressed fracture can cause a distorted appearance of the head.

  • Bleeding.

  • Bruising.

  • A fracture may also lead to seizures.

How Can Skull Fracture Be Diagnosed?

Imaging tests such as skull X-rays, computed tomography (CT) scans, and magnetic resonance imaging(MRI) are required to visualize the bone, bleeding at the site, pressure on the brain, and swelling of the brain. In addition, comprehensive neurological examinations are carried out by the physician.

How To Treat Infant Skull Fractures?

  • The treatment outcome of the fracture depends on the type and severity of the fracture.

  • For linear fractures, complete observation of the fracture is sufficient.

  • For depressed and diastatic fractures, surgical treatment is required. If not treated, blood or fluid may pool in the brain and cause long-lasting damage.

What Is a Clavicular Fracture?

The clavicle is the bone connecting the sternum and shoulder joint, also called the collarbone. The fracture of this collarbone can occur if vaginal delivery is difficult. The leading causes are the large size of the baby, the narrow birth canal, the newborn’s shoulder stuck during delivery, and the use of instruments.

What Are the Symptoms of Clavicular Fracture?

  • Inability to move the painful arms.

  • Lifting the arms of the child would cause pain.

  • A hard lump in the fractured site indicates that the bone is healing.

  • The lump is the actual sign that the newborn had fractured the clavicle.

  • The affected shoulder is at a lower level than the other shoulder.

How Is Clavicular Fracture Diagnosed?

A chest X-ray would help in diagnosing the type and extent of the clavicular fracture. An ultrasound image can also confirm that the clavicle is fractured.

How Is Clavicular Fracture Treated?

There is no treatment generally. However, the baby has to be handled with utmost care. The sleeve of the affected arm can also be pinned to the clothes.

What Is an Infant Humerus Fracture?

The humerus fracture is likely to occur when the baby is born too quickly that the head comes out, but the shoulder is stuck. The umbilical cord is also affected in this situation. In such cases, the physician will do the needful to remove the baby safely. In addition, the humerus fracture is often associated with clavicular fracture. As a result, the baby cannot move the arms due to pain.

How Is Humerus Fracture Treated?

Splinting, casting, or surgery are not recommended for humerus fractures as they can heal alone. But it takes time. Pinning the sleeve to the front would help immobilize and thus reduce pain.

How to Prevent Birth Injuries?

  • Providing proper prenatal care.

  • Addressing the signs of fetal distress.

  • Preventing premature birth.

  • Recognizing whether vaginal birth is possible or C-section is recommended.

  • Caring the premature babies properly in the neonatal intensive care unit.

  • Advise the mother not to smoke, drink alcohol, or take drugs to prevent birth injuries.

  • Doctors, nurses, and other medical professionals should not be negligent during the delivery process.

Conclusion:

Although it is impossible to prevent birth injury, following certain practices during pregnancy and visiting the clinician for a regular follow-up would help minimize delivery complications. In addition, advancements in antenatal care have also created awareness of malformations of the fetus. Hence pregnant women should adhere to the precautionary measures advised by the clinician to avoid a high-risk delivery.

Dr. Suman Saurabh
Dr. Suman Saurabh

Orthopedician and Traumatology

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