Clavicle fracture in newborn
Introduction
Introduction to neonatal clavicle fracture Clavicular fracture is the most common type of birth fracture, and it is related to the mode of delivery, the way the baby is delivered, and the birth weight. Dystocia, fetal transposition is large, and the incidence of giants is high. Neonatal birth injury refers to damage to the fetus or newborn caused by mechanical factors during childbirth. In recent years, due to the strengthening of prenatal examination and the improvement of obstetric techniques, the incidence of birth injury has decreased significantly, but it is still one of the causes of neonatal death and long-term disability, especially in grassroots units. Clavicular fracture is the most common type of birth fracture, and it is related to the mode of delivery, the orientation of the baby, and the birth weight. Most of the children have no obvious symptoms, so they are easily missed. However, when the upper arm activity is reduced or the passive activity is crying, pain, bone glass sound, and even the lumbosacral lumps, the affected side's hug reflex is weakened or disappeared. A small number of children may have fever, a large amount of internal bleeding in the fracture, and a slight increase in body temperature when the hematoma is absorbed, but generally does not exceed 38 ° C. The possibility of infection should be considered when the open fracture temperature rises. There is even shock. basic knowledge The proportion of illness: 0.3% Susceptible people: infants and young children Mode of infection: non-infectious Complications: pediatric malnutrition
Cause
Causes of neonatal clavicle fracture
Dystocia (35%)
In the case of dystocia, the fetus has difficulty in shouldering, and the anterior scapula is squeezed into the pelvic pubic symphysis of the mother, causing the fragile clavicle to bend extremely and fracture. The fracture often occurs in the central or middle 1/3 segment, with a transverse fracture and displacement. There are also incomplete fractures (green branch fractures).
Huge (20%)
If the fetus is too large and the delivery is difficult, the midwife will pull the shoulder of the fetus too hard. When the fetus is delivered to the pelvis, the shoulders will be pressed inwardly and cause a newborn fracture.
Large fetal transposition (10%)
Fetal clavicle bone is fragile, and the degree of fetal transposition is too large, causing the clavicle to hit the maternal birth canal and fracture.
Prevention
Neonatal clavicle fracture prevention
Correctly estimate the relationship between the birth canal and the size of the fetus, and choose cesarean section if necessary. Pay attention to the treatment of dystocia: adjust the effective contractions, while turning the hands, pay attention to help the carcass slowly transposition. At the same time, improve the midwifery technology, carefully and systematically observe the changes in the whole process, master the correct delivery machine: the shoulders are delivered according to the formal operating procedures, the left hand will gently press the neck of the fetus, the right hand will properly protect the perineum, so that the front shoulder self-pubic The bow is delivered first, and then the neck is lifted upwards, so that the back shoulder is slowly delivered from the perineal front.
When cesarean section, we must grasp the timing of fetal delivery, do not blindly absorb amniotic fluid, reduce the pressure of the uterine cavity after amniotic fluid absorption, promote uterine contraction, narrow the incision, which is not conducive to the delivery of the fetus, and the baby will be delivered slowly after the delivery of the baby. Front shoulder.
Complication
Neonatal clavicular fracture complications Complications, malnutrition in children
Increased blood calcium.
Symptom
Symptoms of neonatal clavicular fractures Common symptoms Children crying restless shoulder straps and upper limb pain hug reflection weakened or disappeared
Most of the children have no obvious symptoms, so they are easily missed. However, when the upper arm activity is reduced or the passive activity is crying, pain, bone glass sound, and even the lumbosacral lumps, the affected side's hug reflex is weakened or disappeared. A small number of children may have fever, a large amount of internal bleeding in the fracture, and a slight increase in body temperature when the hematoma is absorbed, but generally does not exceed 38 ° C. The possibility of infection should be considered when the open fracture temperature rises. There is even shock.
Examine
Neonatal clavicle fracture examination
1, X-ray inspection:
X-ray images are required to confirm the diagnosis when a clavicle fracture is suspected. Generally, 1/3 of the clavicle fractures were anteriorly and obliquely inclined at 45° to the head. The shooting range should include the full length of the clavicle, 1/3 of the humerus, the scapula and the upper lung field. If necessary, take a chest radiograph. The anterior and posterior phases can show the up and down displacement of the clavicle fracture, and the 45° oblique phase can observe the anteroposterior displacement of the fracture.
Infants with clavicle without displacement fracture or green branch fracture sometimes difficult to confirm the diagnosis on the original X-ray image, can be reviewed 5 to 10 days after the injury, often with osteophyte formation.
In the outer 1/3 of the clavicle fracture, the X-ray image of the anterior and posterior position and tilting 40° to the head can generally be diagnosed. Sometimes it is necessary to take a shoulder X-ray image to help diagnose the ligament ligament injury. When the stress X-ray image was taken, the patient stood upright and the weight of each wrist was 4.54kg (10 lbs). The upper limb muscles were relaxed and the shoulders were photographed. When the distance between the condyle and the proximal clavicle fracture is significantly widened, the ligament ligament injury is indicated. The external joint surface of the clavicle is fractured. It is sometimes difficult to make a diagnosis by conventional X-ray image. It is often necessary to take a tomographic image or a CT scan.
The 1/3 anterior and posterior X-ray images of the clavicle overlap with the mediastinum and the vertebral body, and it is difficult to show a fracture. Shooting a 40° to 45° X-ray image to the head helps to find the fracture line. X-ray examination is more common, but its misdiagnosis rate is higher. Therefore, it is not satisfied that the X-ray anterior piece has no fracture and is diagnosed as soft tissue injury. It is necessary to carefully check whether there is a clavicle inner end or a local fracture sign. In order to give a correct diagnosis.
2, CT examination: CT examination is the best auxiliary examination method to determine the fracture. Can clearly show the location and extent of the fracture, especially for the fracture of the articular surface is superior to X-ray examination.
Diagnosis
Diagnosis and diagnosis of neonatal clavicle fracture
1. Congenital clavicular pseudoarticular joint is caused by the failure of the two ossification centers inside and outside the clavicle to merge normally during embryonic development. Neonatal manifestations of pseudo-articular activity and mass in the 1/3 of the clavicle at the junction of the clavicle occurred in the right clavicle with age, local deformity increased. Should be differentiated from the clavicle fracture caused by birth injury. X-ray images showed the formation of pseudo-articular joints in the middle and outer corners of the clavicle. The two fractured ends were close to and showed bulb-like masses without clinical symptoms and dysfunction. Long-term follow-up had no effect on the development of acromioclavicular joints and sternocleidal joints. Generally no special treatment is required.
2. Craniotomy is a disorder of family hereditary intramembranous osteogenesis. It can affect the development of clavicle, craniofacial bone and pelvic spine, hand and foot bone. The clinical manifestations of the clavicle are all or part of the lack of X-ray image and congenital clavicular pseudoarthrosis. There are larger gaps at both ends of the bone. The bone ends are tapered and the skull and pelvis ring is missing and the maxillofacial bone is small.
3. The inner end of the clavicle is separated from the inner end of the clavicle and the ossification is later, and the closure is the latest. Therefore, in children and adolescents, the internal end of the clavicle is less likely to have dislocation or fracture of the sterno-lock joint, and the separation of the epiphysis is more likely to occur. The X-ray image shows signs of dislocation of the sterno-lock joint.
4. The fracture of the external clavicle of the acromioclavicular joint dislocation in children is sometimes difficult to distinguish from the acromioclavicular joint in the clinical and X-ray images. If necessary, a tomographic image or CT examination is required.
