Unexpected Sequela of Shoulder Dystocia: Neonatal Humerus Fracture

Shoulder dystocia is an obstetric emergency defined by failure of the fetal shoulders to deliver after expulsion of the head, most often due to impaction of the anterior shoulder behind the pubic symphysis. Although uncommon and considered largely unpredictable, shoulder dystocia carries the risk of significant neonatal morbidity. While brachial plexus injury is the most frequently reported complication, skeletal injuries such as humeral fractures are less commonly described. A 28-year-old primigravid woman with obesity and anemia presented at 38 weeks and 6 days of gestation with spontaneous rupture of membranes and underwent spontaneous vaginal delivery. Shoulder dystocia was identified following delivery of the fetal head. Initial management with the McRoberts maneuver and suprapubic pressure was unsuccessful, followed by unsuccessful attempts at the Woods screw maneuver. Delivery of the posterior arm successfully resolved the dystocia. Post-delivery examination revealed swelling and crepitus of the neonate's right upper extremity with intact perfusion, symmetric Moro reflex, and preserved spontaneous movement. Radiographs confirmed a right mid-diaphyseal humeral fracture with mild angulation and overlap. Conservative management with immobilization and analgesia was initiated. Follow-up imaging at three weeks demonstrated appropriate fracture healing, and the infant remained neurologically intact. Humeral fracture is a rare but recognized complication of shoulder dystocia, particularly following posterior arm delivery. Although such fractures may raise concern for birth trauma, they are typically associated with excellent outcomes when promptly identified and managed conservatively. This case illustrates appropriate escalation of shoulder dystocia maneuvers in accordance with established protocols and emphasizes the importance of thorough neonatal assessment to distinguish skeletal injury from neurologic compromise. This report highlights neonatal humeral fracture as an uncommon complication of shoulder dystocia and reinforces that, despite the urgency of delivery, careful technique and prompt postnatal evaluation can result in favorable outcomes with minimal long-term morbidity.