Presentation
Neonate with excessive crying and restricted left thigh movement for the last one day after one of his daily neonatal massage.
Patient Data
There is cortical buckling with linear lucency in the proximal diaphysis of the left femur. It is associated with adjacent soft tissue swelling.
There is subperiosteal fluid involving the left proximal femoral diaphysis. There is a breach in underlying femur cortex. Adjacent muscle edema.
Case Discussion
This fracture was as a result of overzealous neonatal massage. Infant massage is an ancient practice in some parts of the world; Asia, Middle east and Africa. It is believed that massage works by instilling fearlessness, hardening bone structure, enhancing movement and limb coordination, and increasing weight 3. There is however no current scientific evidence to support its benefits 2.
Non-accidental injury should be considered in any non ambulant child with a long bone fracture. In this case, three different persons ( radiographer, radiologist and referring pediatrician ) talked to the parents and etiology of massage as a cause of fracture is very certain. The pediatricians in our institution do report fractures as a consequence of infant massage.
Biochemical profile was not performed as the referring pediatrician had no clinical doubt about other underlying pathology.