Perinatal Femur Fracture Following Difficult Cesarean Delivery: A Case Report

Neonatal femur fractures from birth trauma are rare, occurring in 0.1 to 2 per 1000 live births, with unclear associations with cesarean delivery. Limited literature leaves gaps in early detection, injury mechanisms, and management.

This is the case of a full-term female neonate with a femur fracture following a cesarean delivery for breech presentation. The delivery involved a difficult extraction, and the fracture was diagnosed immediately due to crepitus and a "popping" sound. Treatment was complicated by insurance. The patient received a Pavlik harness with good healing.

In the literature, diagnosis averages 4 days, relying on late-arising classic signs. The literature is mixed on risks associated with mode of delivery.

Challenging cesarean extractions pose a risk for femur fractures. Early diagnosis is essential and may be expedited by comprehensive screening and early physical exam findings, such as crepitus, a "popping" sound, or decreased limb mobility. Poor access to pediatric orthopedic clinicians may complicate treatment.