Zhu Guanghui,Mei Haibo,Liu Kun,et al.Experience of diagnosing and treating neonatal humeral obstetric fracture: a report of 12 cases[J].Journal of Clinical Pediatric Surgery,,18():959-963.[doi:10.3969/j.issn.1671—6353.2019.11.012]
Experience of diagnosing and treating neonatal humeral obstetric fracture: a report of 12 cases
- Keywords:
- Humeral Fractures; Birth Injuries; Diagnosis; Therapy; Infant; Newborn
- CLC:
- R726.8;R683;R722.14
- Abstract:
- Objective To explore the early diagnosis,treatment and prognosis of neonatal humeral obstetric fracture.Methods A retrospective analysis was conducted for 12 cases of neonatal humeral obstetric fracture from August 2006 to January 2017.The clinical data of gestational age,birth weight,delivery mode,placental position,age of treatment,injury site,side,combined injury,treatment method,fixing time and treatment outcomes were documented.Results There were 8 boys and 4 girls.The involved side was left (n=5),right (n=6) and bilateral (n=1).The gestational age was <37 weeks (n=6),37-42 weeks (n=5) and >42 weeks (n=1).The birth weight was (3 042.5±825.9) gram with breech presentation (n=7) and cranial projection (n=5).There were humeral shaft fracture (n=9),proximal humeral epiphysiolysis (n=1) and distal humeral epiphysiolysis (n=2).The combined injuries were clavicular fracture(n=3),radial nerve injury (n=2),scalp hematoma (n=3),brachial plexus injury (n=1).Four cases had no combined injury.The age of admission was between 1-14 days.Five patients were transferred into our department immediately after humeral fracture at birth.The diagnosis was delayed for the remainders.The diagnostic time was>1 week (n=3).Humeral epiphysiolysis (n=2) was diagnosed by elbow arthrography and the remainders were diagnosed by radiology.The fixation methods were plaster (n=3),small splint (n=8) and elastic bandage (n=1).Extensive callus formation at fracture was revealed by radiography in two cases with humeral epiphysiolysis at admission and was managed by in situ plaster or bandage.Reexamination at 2-3 weeks after removing fixation showed a large amount of callus growth.The average follow-up period was 45 (18-60) months.Radial nerve injury recovered completely within 3-6 months.One case failed to recover from brachial plexus injury and developed upper limb dysfunction.And another case 3 had a residual cubitus varus of 15 degrees.During the last follow-up,Mayo elbow function score (93.8±11.8) was obtained in 12 cases (13 limbs) with an excellent/good rate of 92.3% (12/13).Neer shoulder function score was excellent (93.5±14.8) and achieved a good rate of 92.3%(12/13).The function of shoulder and elbow joint were normal except for one.Conclusion Neonatal humeral obstetric fracture should be diagnosed with radiology,ultrasound,MRI and other auxiliary methods as soon as possible and managed by early conservative treatment.It heals well after 2-3 weeks.Neonatal humeral fracture has strong shaping ability.Distal humeral epiphysiolysis may lead to cubitus varus while humeral shaft fracture and proximal humeral epiphysiolysis scarely cause sequel deformity.
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Memo
收稿日期:2019-06-05。
基金项目:湖南省自然科学基金青年基金（编号：2017JJ3140）；湖南省儿童医院"青年英才"培养计划
通讯作者:梅海波,Email:meihaibo@sohu.com