Birth fractures of long bones

The incidence of birth injuries of the skeleton is two fractures to every thousand live births. The most frequent is a clavicular fracture, while fractures of long bones are rarely seen. During the period from 1988 to 1998, twelve neonates were treated at the Clinic for paediatric surgery in Children`s hospital Zagreb: two with proximal epiphyseal separation of humerus, ten with diaphyseal fractures of the humerus and eight with diaphyseal fractures of the femur. The newborns treated had one or more risk factors such as: high birth weight, breech delivery, twins, prolonged labor, manual reposition of pathologic child position in utero, Cesarean section. The diagnosis of proximal epiphyseal separation of the humerus was made on the basis of clinical signs, comparative rentgenograms of the upper arms in abducted and adducted positions, and ultrasound examination of the shoulder joint. After epiphyseal reduction, the upper arm was immobilized in Velpeau`s bandage for two weeks. After removing the bandage, temporary swelling persisted in the shoulder region, without functional limits of the shoulder joint. Diaphiseal fractures of the humerus, after radiological diagnosis, were reducted and immobilized with a Dessault` s bandage. Immobilization lasted for three weeks with periodical radiological control. After removing of the bandage and physical rehabilitation, full functional recovery was achieved. Fractures of the femoral shaft were treated by extension during two weeks, and another two weeks in coxofemoral cast. Because of rapid callus remodelling of the femoral diaphysis, adequate longitudinal bone axis was achieved, although at the beginning of treatment marked angulation of bone fragments was often present. While the diagnosis of diaphyseal fracture of the humerus and femur is simple, and the treatment results are good; diagnosis of proximal epiphyseal separation of the humerus is more demanding, because of the radiologically invisible epiphysis. The therapeutic procedure demands good reduction to avoid deformity of the shoulder and functional disorder.