Neonatal Obstetrics Fractures: Incident, Risk Factors and Management Outcome in North-West Nigeria

Lukman Olalekan Ajiboye1 *, Chukwuma Rolland Nwashili1 , Abdullahi Adoke2 and Ridwan Jega3

1Department of Orthopedics and Trauma, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria 2Department of Obstetrics and Gynecology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria 3Special Care Baby Unit, Institute of Child Health, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

^*Correspondance to: Lukman Olalekan Ajiboye 

 PDF  Full Text Research Article | Open Access

Abstract:

Background: Obstetric fractures following birth injuries in newborns are not rare in our practices unlike in the developed climes. It may cause anxiety, socioeconomic and emotional challenges to the patient’s relatives and a major concern to health care providers especially the attending physicians. These fractures can also cause a spectrum of morbidity/deformity if not well managed. Publications on the incident, risk factors, management and its outcomes are scarce in literature search. We analyzed our experiences regarding this study in Usmanu Danfodiyio Teaching Hospital, Sokoto, Nigeria. Objectives: The objectives of this study are (1) To determine the incidence of obstetric neonatal fractures (2) To identify the common risk factors of obstetric neonatal fractures and (3) To examine the management outcome in the study centre. Type of study: Retrospective cross-sectional analytical study. Methods: The diagnoses of obstetric fractures or injuries were traced from the hospital health record department. Seventy-five cases of obstetric fractures were seen, evaluated and managed between January 2018 and December 2020. The demographic details, incident, risk factors during birth, mode of delivery, type and sites of fracture, and management used with outcomes were documented. The findings were analyzed using SPSS version 24. Results: Seventy-five cases were recruited. Thirty-three babies were delivered in UDUTH while forty-two were delivered at home and peripheral hospitals. Mean gestational age was 37.6 weeks (ranging from 35 to 41 weeks). Mean time for the diagnosis or consultation by an orthopedic surgeon was 3.7 days (ranging from few hours to 11 days). Most patients had difficulty deliveries: breech presentation by SVD (9.3%), breech presentation by caesarean section (6.7%), cephalic presentation by SVD (52%), cephalic presentation by caesarean section (16%), cephalic presentation with assisted instrumental delivery (9.3%) and cephalic presentation with shoulder dystocia (6.7%). Out of the 33 cases delivered in UDUTH, majorities (26.7%) were not booked and had no antenatal assessment and care. Majority (62.7%) of all the studied cases had prolonged labor duration while 37.3% had normal duration of labor. Our study revealed incidence of obstetric fracture in our hospital (UDUTH) is 1.169 per 1000 deliveries. The frequencies of the fractures are tibia with or without fibula (4%) femur (34.7%), clavicles (37.3%), and humerus (24%). The treatment offered for the fractures include: Watchful waiting/ observation with instructions on positioning (62.7%) and splint with plaster of Paris (37.3%). All patients showed complete union at the end of 6 weeks with no residual deformity or limb length discrepancy at the end of 16 weeks. A significant number of the patients were lost to follow up after 16 weeks with only 13% had follow up to 6 months. Conclusion: The occurrence of neonatal obstetric fractures is not rare in our settings. Obstetricians and neonatologists should routinely practice thorough clinical examinations for any new born with obstetrics trauma risk factor(s) and when in doubt early orthopedic surgery consultation will help in early diagnosis and appropriate management. Type of management is guided by many factors with patient’s neonatal condition well taken into consideration. This study revealed satisfactory outcome. Efforts should be made at peripheral hospitals towards obstetric care, early referral of high-risk pregnancies to specialists as well as public enlightenment against home deliveries of babies.

Keywords:

Neonate; Obstetric fracture; Risk factors; Incidence; Management

Cite the Article:

Ajiboye LO, Nwashili CR, Adoke A, Jega R. Neonatal Obstetrics Fractures: Incident, Risk Factors and Management Outcome in North-West Nigeria. World J Surg Surgical Res. 2021; 4: 1332..