Predisposing factors in obstetrical fractures

To compare various obstetrical methods with different types of obstetrical fractures, 29 neonates with fractures were evaluated retrospectively. Plain films of skull, limbs and chest were obtained. Transfontanellar ultrasonography was performed in one case and a computed tomographic scan of the skull in two. We reviewed 12 fractures of long bones, 7 fractures of the skull, and 10 fractures of the clavicle. Ten fractures occurred during caesarean sections and 11 in vaginal delivery requiring medical assistance. Depressed skull fractures were associated with manoeuvres and the use of forceps during delivery. Fractures of the long bones were associated with caesarean section, breech delivery with assistance and low birth weight. All fractures were treated conservatively except for skull fractures with depression of more than 2 cm. Early consolidation occurred in all fractures of long bones. The long-term follow-up of all fractures but one revealed no persisting disability. The belief that obstetrical fractures occur primarily in large babies or after breech delivery is not supported by this study.