Treatment of Humerus Fractures Occurring at Time of Delivery
Birth-related humerus fractures should be treated conservatively with immobilization using a high above-elbow slab with an arms-chest bandage for approximately one week, followed by gentle passive range of motion exercises after evidence of healing.
Diagnosis and Assessment
Neonatal humerus fractures may present with:
- Decreased or absent movement of the affected limb
- Swelling and contusion of the arm
- Crepitus and abnormal mobility
- Crying when the affected area is manipulated
- Must be differentiated from brachial plexus injury (Erb's palsy)
Radiographic evaluation is essential to confirm diagnosis and determine fracture pattern 1
Treatment Approach
Conservative Management
- Non-operative treatment is the standard of care for neonatal humerus fractures occurring during delivery 1
- Treatment consists of:
- Immobilization with a high above-elbow slab
- Arms-chest bandage for approximately one week
- Close follow-up to monitor healing
Follow-up Care
- Clinical and radiographic follow-up should begin at 1-2 weeks after initial treatment 2
- Begin gentle passive range of motion exercises at approximately 4 weeks, once radiographic evidence of healing is present
- Progress to active-assisted range of motion as tolerated
- Regular follow-up for at least 6 months to monitor for:
- Return to normal function and mobility
- Potential complications such as premature physeal closure
Special Considerations
- While most birth-related humerus fractures occur during vaginal breech deliveries, they can also occur during cesarean sections due to forceful maneuvers or traction 1, 3
- Bilateral humerus fractures, though extremely rare, have been reported during cesarean deliveries for breech presentation 3
- These injuries may go unnoticed by the delivering obstetrician or be misinterpreted as brachial plexus injury 1
Prognosis
- With appropriate and timely management, the prognosis for neonatal humerus fractures is excellent
- The extensive remodeling capacity of the proximal humerus in skeletally immature patients accommodates a large degree of fracture displacement and angulation 4
- Most patients achieve full functional recovery without long-term sequelae
Prevention
- Obstetricians and pediatricians should remain vigilant for the rare occurrence of humerus fractures during delivery
- Careful extraction techniques during difficult deliveries can help minimize the risk of fracture
- Early recognition and appropriate management are essential to prevent future disability and deformity 1