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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
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LETTER TO EDITOR
Year : 2010  |  Volume : 15  |  Issue : 3  |  Page : 112
 

Obstetrical fractures of the femur in developing countries: Predisposing factors and therapeutic approach


Department of Pediatric Surgery, Hospital Aristide Le Dantec, Dakar, Senegal

Date of Web Publication18-Oct-2010

Correspondence Address:
Issa Amadou
Department of Pediatric Surgery, Hopital Aristide Le Dantec, BP 6863 Dk-Etoile, Dakar
Senegal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.71743

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How to cite this article:
Ngom G, Fall M, Amadou I, Munyali DA. Obstetrical fractures of the femur in developing countries: Predisposing factors and therapeutic approach. J Indian Assoc Pediatr Surg 2010;15:112

How to cite this URL:
Ngom G, Fall M, Amadou I, Munyali DA. Obstetrical fractures of the femur in developing countries: Predisposing factors and therapeutic approach. J Indian Assoc Pediatr Surg [serial online] 2010 [cited 2019 Nov 15];15:112. Available from: http://www.jiaps.com/text.asp?2010/15/3/112/71743


Sir,

Obstetrical fracture of the femur is uncommon. [1] It ranks third among obstetrical fractures of bones, after the fractures of the clavicle and the humerus. [2] The main risk factors identified are breech delivery, caesarean section, macrosomia, primiparity, twin pregnancy and fetal osteoporosis. [3],[4]

Treatment for this condition uses three methods: spica cast, Pavlik harness and Bryant traction. [1],[5] Each method has advantages and drawbacks, but the results are overall good and equivalent.

In Senegal, this fracture ranks second in position after the fracture of the clavicle. Between January 1996 and December 2007, 51 neonates presented with 52 obstetrical fractures of the femur, which account for 7.5% of all femoral fractures noted in children. Ours' is the largest ever reported series in the literature. Risk factors identified were breech delivery, macrosomia, twin pregnancy and osteogenesis imperfecta.

Primiparity was not identified as a risk factor because most women were multiparous (70%). However, we have identified an additional risk factor represented by home delivery. This practice has caused 33.3% of obstetrical fractures. It is performed at home by women who received no health training. This situation is common because most of the population is poor and cannot afford safe delivery.

Spica cast is not readily performed in our department because it requires general anesthesia, which can be hazardous to a newborn in a developing country where pediatric anesthesia is not well controlled. Pavlik harness is not readily available in our daily practice. We use Bryant traction for 10 days supplemented by spica cast for 2 weeks. Our results are excellent: no skin complications or vascular and nervous complications or malunion.

In conclusion, obstetrical fractures of the femur are not an exceptional occurrence in our context. One-third of these fractures are caused by home delivery performed by unskilled women. Treatment involves Bryant traction followed by spica cast, which seems to be the best method in our developing countries, especially in terms of safety for neonates.

 
   References Top

1.Morris S, Cassidy N, Stephens M, Mc Cormack D, Mc Manus F. Birth- associated femoral fractures: Incidence and outcome. J Pediatr Orthop 2002;22:27-30.  Back to cited text no. 1      
2.Gordon AB, Fletcher MA, Mc Donald GM. Neonatology, Pathophysiology and Management of the Newborn. 5 th ed. Philadelphia: Lippincott Williams and Wilkins; 1999. p. 1280-1.  Back to cited text no. 2      
3.Givon U, Sherr-Lurie N, Schindler A, Blanhstein A, Ganel A. Treatment of femoral fractures in neonates. Isr Med Assoc J 2007;9:28-9.  Back to cited text no. 3      
4.Toker A, Perry ZH, Cohen E, Krymko H. Cesarean Section and the Risk of Fractured Femur. Isr Med Assoc J 2009;11:416-8.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Tachdjian MO. Obstetrical or birth injuries. Chapter 8. Fractures and dislocations. In: Tachdjian MO, editor. Pediatric Orthopaedics. 2 nd ed. Philadelphia: WB Saunder; 1990. p. 3352.  Back to cited text no. 5      




 

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