Diaphyseal Fracture of the Humerus during Elective Cesarean Section - A Rare Case Report

Humeral fractures are the second common long bone fractures of the neonatal period after clavicle. Most cases of birth-related humerus fracture are reported during a vaginal breech delivery. The cesarean section does not eliminate the risk of long bone fractures. A humerus fracture is less common but still can happen due to forceful maneuvers like traction during cesarean which can go unnoticed to operating obstetrician or misinterpreted as brachial plexus injury by an inexperienced orthopedic surgeon.

We received a call from the neonatal intensive care unit (NICU) for a 2-day-old 2.4 kg male baby delivered to primigravida at 37 weeks by elective cesarean for transverse lie, for not moving his right upper limb. On examination by orthopedic surgeon, swelling, contusion, crepitus, and abnormal mobility at the right arm were noticed. Gentle manipulation made the neonate cry. Range of movements (ROMs) of wrist, elbow, and hand were within normal limit without any neurovascular deficit. Hence, the initial diagnosis of brachial plexus injury/Erb's palsy was revised. X-ray of the right upper limb was ordered which showed an isolated mid-shaft humerus bicortical fracture. A high above elbow slab was applied with an arms chest bandage for a week and the baby was discharged with proper advice to the mother to follow-up on the next week.

Obstetricians and pediatricians should remain vigilant for the rare occurrence of humerus fracture during cesarean so that they are not missed and managed timely to prevent future disability and deformity.