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

  • CLAUDIA FANTACCI1
  • LUCA MASSIMI2
  • DOMENICO CAPOZZI1
  • VALERIO ROMANO1
  • PIETRO FERRARA1
  • ANTONIO CHIARETTI1

1Department of Pediatrics, Catholic University of Sacred Heart

2Pediatric Neurosurgery, Catholic University of Sacred Heart

DOI: 10.22514/SV101.042015.11 Vol.10,Issue 1,April 2015 pp.103-109

Published: 30 April 2015

*Corresponding Author(s): CLAUDIA FANTACCI E-mail: claudiafantacci@yahoo.it

Abstract

“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.

Keywords

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

Cite and Share

CLAUDIA FANTACCI,LUCA MASSIMI,DOMENICO CAPOZZI,VALERIO ROMANO,PIETRO FERRARA,ANTONIO CHIARETTI. “Spontaneous” ping-pong fracture in newborns: case report and review of the literature. Signa Vitae. 2015. 10(1);103-109.

References

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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.

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