“Spontaneous” ping-pong fracture in newborns: case report and review of the literature

“Ping-pong” fractures (PPF) are depressed skull fractures typical of newborns. PPF usually result from head injury and, rarely, may cause severe long-term neurological sequelae. The management of PPF is still controversial. The goal of this paper is to present a case of “spontaneous” ping-pong fracture and to review the pertinent literature of the last 20 years. We report on a newborn who presented with a “spontaneous” parietal depressed skull fracture at birth. Preoperative computed tomography (CT) scan confirmed the PPF and excluded brain injuries. Neurosurgical intervention was performed on day 3 with immediate lifting of the fracture; the postoperative course was uneventful.

During the last 20 years, 22 cases of “spontaneous ping-pong” fractures in newborn have been reported, with different clinical pictures and management but, generally, with a good outcome.

“Ping-pong” fractures can occur in uneventful pregnancies and after uncomplicated vaginal or cesarean deliveries. CT scan, with low-dose protocol for infants, is the gold standard examination to evaluate the fracture and any associated brain lesions. Treatment is selected according to fracture characteristics.

ping-pong fracture, newborns, CT scan, delivery, neurosurgery

1. Mastrapa TL, Fernandez LA, Alvarez MD, Storrs BB, Flores-Urueta A. Depressed skull fracture in Ping Pong: elevation with Medeva extractor. Childs Nerv Syst 2007;23:787-90.

2. Zalatimo O, Ranasinghe M, Dias M, Iantosca M. Treatment of depressed skull fractures in neonates using percutaneous microscrew elevation. J Neurosurg Pediatr 2012;9:676-9.

3. Dupuis O, Silveira R, Dupont C, Mottolese C, Kahn P, Dittmar A, et al. Comparison of “instrument-associated” and “spontaneous” obstetric depressed skull fractures in a cohort of 68 neonates. Am J Obstet Gynecol 2005;192:165-70.

4. Natelson SE, Sayers MP. The fate of children sustaining severe head thrauma during birth. Pediatrics 1973;51:169-74.

5. Aliabadi H, Miller J, Radnakrishnan S, Mehta AI, Thomas K, Selznick L, et al. Spontaneous intrauterine “ping-pong” fracture: review and case illustration. Neuropediatrics 2009;40:73-5.

6. Chiaretti A, De Benedictis R, Della Corte F, Piastra M, Viola L, Di Rocco C. The impact of initial management on the outcome of children with severe head injury. Child’s Nervous System 2002;18:54-60.

7. Basaldella L, Marton E, Bekelis K, Longatti P. Spontaneous resolution of atraumatic intrauterine ping-pong fractures in newborns delivered by cesarean section. J Child Neurol 2011;26:1449-51.