Obstetric fractures in caesarean delivery and risk factors as evaluated by paediatric surgeons

• Published in: International orthopaedics 2022-11, Vol.46 (11), p.2611-2617
• Main Authors: Ulici, Alexandru, Herdea, Alexandru, Dragomirescu, Mihai-Codrut, Lungu, Claudiu N.
• Format: Article
• Language: English
• Subjects: Brachial Plexus Neuropathies - complications; Cesarean Section - adverse effects; Child; Dystocia - epidemiology; Dystocia - etiology; Female; Fractures, Bone - complications; Fractures, Bone - etiology; Humans; Infant, Newborn; Medicine; Medicine & Public Health; Original Paper; Orthopedics; Pregnancy; Retrospective Studies; Risk Factors; Surgeons
• ISSN: 0341-2695; 1432-5195
• DOI: 10.1007/s00264-022-05547-2

Introduction Obstetric fractures usually occur after complicated births and are sent to paediatric orthopaedics for treatment and follow-up. Clavicle fractures represent the most common orthopaedic birth injury, involving approximately 0.2 to 3.5% of births. Hypotheses Caesarean delivery, elective or necessary, along with the type of presentation, may play a determinant role in the aetiology of obstetric fractures. Materials and methods We chose to do a retrospective study to determine possible risk factors for this type of injury that may manifest in either delivery. Our aim was to deepen our knowledge in order to have a better prediction and a better management of this condition. Data gathered included parity, gestity, type of delivery, presentation, shoulder dystocia, type of fracture, birth weight, and APGAR score. Results We followed 136 patients that were diagnosed with Allman type I clavicle fracture, 32 of them also having brachial plexus birth palsy (BPBP) type 1 (Duchenne-Erb). Natural birth with a pelvic presentation imposes a relative risk of 6.2 of associated pathology compared to cranial presentation. Caesarean delivery and cranial presentation increase the risk of related pathology by 5.04 compared to natural birth. Statistically, pelvic presentation is 5.54 times more likely to develop related pathology than cranial presentation. Type of delivery and presentation correlate with associated pathology of clavicle fractures. Discussion and conclusion Caesarean delivery brings risks for the newborn and should be practiced only when necessary. Predictive modeling in obstetrics in third-trimester evaluations may statistically predict risks of birth complications like fracture and BPBP.