Neonatal upper limb fractures - a narrative overview of the literature

Abstract

The aim of this paper is to review the topic of neonatal fractures of the upper limb, describing the different types of fractures focusing on the etiology, epidemiology, risk factors, clinical approach, diagnosis, treatment and prognosis of these injuries. We included all types of research studies, both experimental and observational, published in English, French, Portuguese and Spanish. The information was obtained using the keywords neonatal upper limb fracture, clavicle fracture or humerus fracture from the following resources: MEDLINE database, Embase^® database and LILACS database. Other resources such as hand searches of the references of retrieved literature and authoritative texts, personal and hospital libraries searching for texts on upper limb neonatal fractures, discussions with experts in the field of upper limb neonatal fractures and personal experience, were also considered for the completion of the article.Neonatal fractures of the upper limb are consensually considered to have a good prognosis and no long-term sequelae. Conservative treatment is the option in the vast majority of the fractures and is associated with excellent results, with good healing, full range of motion, adequate remodeling without obvious deformity, neurologic impairment or functional implications.

Keywords: Clavicle fracture; Humerus fracture; Neonatal upper limb fractures.

Fig. 1

Male neonate, macrosomic (4024g), shoulder dystocia and instrumental delivery, with a right humeral shaft fracture, diagnosed on the 1st day of life, after limb deformity and humerus crepitus noticed immediately after delivery. Treatment was carried out with soft immobilization, placing the affected limb with the sleeve of a long-sleeved shirt attached to the chest with the elbow at 90º flexion. a X-ray on day 1 showing a right middle shaft humerus fracture with significant displacement. b At 3 weeks follow-up: X-ray with evidence of bone callus and indication for passive and active mobility of the right upper limb. c At 10 months follow-up: the patient was clinically without symptoms or restrictions and the X-ray shows clear evidence of consolidation and remodeling of the fracture

Fig. 2

Male neonate, instrumented delivery, with a left clavicle fracture, diagnosed on the second day of life after perception of decreased mobility of the upper limb and crepitus of the clavicle. a X-ray on day 2 showing a middle third left clavicle fracture with deviation. b At 10 months follow-up: patient clinically without symptoms or restrictions and the X-ray shows clear evidence of consolidation and remodeling of the fracture