Neonatal humeral fracture

Case contributed by Ashesh Ishwarlal Ranchod
Diagnosis certain


A term baby with dystocia of the shoulder.Request for "babygram".

Patient Data

Age: 1 day
Gender: Male

The lung fields are mildly hyperinflated with surfactant deficiency disorder.
Normal cardio mediastinal and right thymic contour. The patient is intubated, the ET tube is at approximately T2/T3 vertebral body level and appears correctly sited.
The umbilical venous catheter is subdiaphragmatic, curled distally (likely within the left portal vein) and should be retracted and resited.
The umbilical arterial catheter is poorly appreciated; however, the tip appears satisfactorily sited at the T6 vertebral body level. Overlying temperature lead. There is a non-specific bowel gas pattern with no evidence of NEC. Splenomegaly is not excluded due to the eccentric left hypochondrial impression.
The humeral ossification centers appear absent suggesting prematurity.

There is a displaced fracture through the midshaft of the right humerus with angulation and foreshortening. The clavicles specifically are intact and normal bilaterally. The left humerus and bilateral radius and ulna appear normal. There are 12 pairs of ribs. The visualized bony pelvis and proximal femurs are normal.

(The dedicated skull and lower limb views have not been uploaded).

Case Discussion

The case demonstrates an example of a humeral shaft fracture in a case of shoulder dystocia. Clavicular fractures are usually more common than humeral fractures in shoulder dystocia. The new-born baby weighed 3.9 kg, which appears to be the only possible risk factor in this instance.

The baby was born at 40 weeks' gestation. The maternal age was normal rather than advanced, there is no history of known or occult gestational diabetes mellitus. The mum (P2G3) of normal height experienced a reasonable 1st and 2nd stage of labor.

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