Understanding Fractures and Dislocations in Newborns: Causes, Effects & Care

Fractures and dislocations in newborns, while less common than other birth injuries, can occur during childbirth, leading to significant concerns about an infant’s health and development. These injuries require prompt and careful management to ensure proper healing and to minimise potential long-term complications.

Causes of Fractures & Dislocations in Newborns

Fractures and dislocations in newborns may result from various factors during labour and delivery:

• Physical Trauma: Difficult or prolonged births can result in physical trauma to the infant. Shoulder dystocia, where the baby’s shoulder becomes lodged behind the mother’s pubic bone, is a common complication that can place excessive force on the infant’s skeletal system.
• Use of Delivery Instruments: Delivery tools like forceps or vacuum extractors may increase the risk of fractures and dislocations, particularly if applied with excessive force.

The clavicle (collarbone) is the most frequently fractured bone in newborns, especially in larger babies or when shoulder dystocia complicates delivery. Other possible injuries include fractures of long bones like the humerus or femur, as well as joint dislocations, particularly of the hip.

Consequences of Fractures & Dislocations

The effects of fractures and dislocations in newborns vary based on the injury’s severity and location:

• Neonatal Fractures: Fractures, such as those of the clavicle, generally heal with minimal intervention but may cause temporary discomfort and affect limb movement or positioning. Some fractures may result in a visible lump or bump at the healing site, and while rare, nerve damage can occur if the fracture affects surrounding tissues.
• Hip Dislocations: Developmental dysplasia of the hip (hip dislocation) is more serious if untreated. Hip dislocations can lead to walking and posture issues as the child grows, potentially resulting in long-term orthopaedic complications. Early detection and treatment are vital to ensure proper joint development and to prevent later complications like osteoarthritis.

Beyond the physical impact, equally significant is the psychological impact of birth injuries on both the infant and the family.

Management of Fractures & Dislocations

Managing fractures and dislocations in newborns requires a tailored approach focused on healing and comfort:

• Fracture Treatment: Most neonatal fractures, such as clavicle fractures, are treated conservatively. Immobilisation with slings or splints allows the bone to heal naturally, while pain management ensures the infant remains comfortable. Regular follow-ups are essential to monitor healing and to confirm that the bone heals correctly.
• Dislocation Treatment: Hip dislocations may require more intensive treatment. Early diagnosis, through physical exams or ultrasound, is critical. Treatment might involve a Pavlik harness to keep the hip in the correct position, and in some cases, surgery may be necessary. Ongoing monitoring is crucial for joint development and to prevent long-term complications.

Prevention of Fractures & Dislocations

Preventing fractures and dislocations in newborns involves proactive prenatal and birthing care:

• Careful Prenatal Assessment: Accurate assessment of the baby’s size and position before delivery can inform safer delivery techniques.
• Controlled Instrument Use: Avoiding excessive force, especially with tools like forceps or vacuum extractors, is essential. Healthcare providers should be trained to recognise and address complications such as shoulder dystocia safely.
• Maternal Health: Ensuring that the mother receives adequate prenatal nutrition and care supports healthy fetal development and reduces the risk of complications that could lead to birth injuries.

Early and proactive interventions are key to minimising the risk of fractures and dislocations in newborns.

Legal Standpoint

From a legal perspective, fractures and dislocations sustained during birth may be grounds for a medical negligence claim if they resulted from improper management during delivery. Key factors include:

• Excessive Force: If it is determined that excessive force was used during delivery, or if there was a failure to address a complication like shoulder dystocia, affected families may pursue compensation.
• Evidence Review: Legal claims require a thorough review of medical records and consultations with medical experts to evaluate whether the standard of care was met.

Guidelines from organisations such as the National Institute for Health and Care Excellence (NICE) and the Royal College of Obstetricians and Gynaecologists (RCOG) serve as benchmarks for appropriate care during childbirth. Deviations from these guidelines may indicate negligence. Compensation in these cases may cover the costs of medical treatment, ongoing care, and any long-term effects like developmental delays or orthopaedic issues.

Families looking for guidance on how to get compensation for birth trauma are advised to consult with a solicitor experienced in birth injury claims.

Conclusion

Fractures and dislocations in newborns, while uncommon, require prompt and effective management to ensure proper healing and to minimise the risk of long-term complications. Understanding the causes, consequences, and management strategies for these injuries is essential for providing appropriate care. Additionally, exploring available legal avenues can help affected families secure the resources needed to support their child’s recovery and long-term well-being.

If you believe your newborn has suffered an injury due to a traumatic birth, contact us for expert assistance in birth injury claims.