Bilateral Neonatal Hummers Shaft Fracture During Elective Cesarean Section – A Rare Case Repor
Abstract:
Background: Humeral fractures are the second common long bone fractures of the neonatal period after clavicle. Most cases of birth-related hummers fracture are reported during a vaginal breech delivery. The cesarean section does not eliminate the risk of long bone fractures. A hummers fracture is less common but still can happen due to forceful maneuvers like traction during cesarean which can go unnoticed to operating obstetrician or misinterpreted as brachial plexus injury by an inexperienced orthopedic surgeon. Case Report: We received a call from the neonatal intensive care unit (NICU) for a 5-day-old 2.9 kg male baby de livered to primigravida at 38 weeks by elective cesarean for transverse lie, for not moving his both upper limbs. On examination by orthopedic surgeon, swelling, contusion, crepitus, and abnormal mobility at the both arms were no ticed. Gentle manipulation made the neonate cry. Range of movements (ROMs) of wrist, elbow, and hand were within normal limit without any neurovascular deficit. Hence, the initial diagnosis of brachial plexus injury/Erb’s palsy was revised. X-ray of the right and left upper limb was ordered which showed an isolated mid-shaft bilateral hummers biocritical fracture. A high U shape slab was applied for a week and the baby was discharged with proper advice to the mother to follow-up on the next week. Conclusion: Obstetricians and pediatricians should remain vigilant for the rare occurrence of hummers fracture during cesarean so that they are not missed and managed timely to prevent future disability and deformity.
