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Qudsieh SMA, Al Barbarawi MM, Altal OF, Barbarawi AMA, Al-Zoubi RM, Al Zoubi MS. Depressed "ping pong" skull fractures in the newborns: A cohort study. Health Sci Rep 2024; 7:e2283. [PMID: 39323458 PMCID: PMC11423336 DOI: 10.1002/hsr2.2283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 07/08/2024] [Accepted: 07/22/2024] [Indexed: 09/27/2024] Open
Abstract
Background and Aims A ping pong fracture is a rare depressed skull fracture (DSF) observed in infants. It occurs due to the inward buckling of the calvarium, creating a cup-like shape. Trauma during childbirth, particularly from instrumental delivery or the application of pressure by physicians or midwives during challenging deliveries, is the primary cause. This study aimed to investigate the epidemiologic characteristics associated with DSF in newborns and to identify the main factors related to its incidence and the type of hematoma involved. Methods This is a retrospective case-control analysis of all newborns delivered with DSF at King Abdulla University Hospital in Jordan between January 2008 and December 2020. The medical records were reviewed, and clinical data were collected and analyzed. Results Out of 42,955 live births delivered at King Abdulla University Hospital, 13 cases of DSF were observed, giving an incidence of 3.0 in 10,000 live births. All cases were delivered at full term. Of the 13 cases, nine cases were associated with the use of instrumental delivery. Seven of those nine cases were delivered vaginally, while the other two cases required cesarean section following unsuccessful instrumental delivery. Four cases were spontaneous, with no history of trauma or instrument use, and delivered by cesarean section. Only 3 of the 13 cases required neurosurgical elevation of DSF. The outcome was excellent in all cases, both cosmetically and neurologically. Conclusion Ping-pong skull fractures are seen in newborns infrequently in the Jordanian population, with an incidence of 0.03%. Most of the cases have resulted from difficult deliveries though spontaneous fractures can be encountered rarely. The treatment is usually conservative with spontaneous resolution. The overall prognosis is excellent both neurologically and cosmically.
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Affiliation(s)
- Suhair M A Qudsieh
- Department of Clinical Sciences, Division of Obstetrics and Gynecology, Faculty of Medicine Yarmouk University Irbid Jordan
| | - Mohammed M Al Barbarawi
- Department of Neurosurgery, Faculty of Medicine Jordan University of Science and Technology Irbid Jordan
| | - Omar F Altal
- Department of Obstetrics and Gynecology, Faculty of Medicine Jordan University of Science and Technology Irbid Jordan
| | - Ala M Al Barbarawi
- Faculty of Medicine Jordan University of Science and Technology Irbid Jordan
| | - Raed M Al-Zoubi
- Surgical Research Section, Department of Surgery Hamad Medical Corporation Doha Qatar
- Department of Biomedical Sciences, QU-Health, College of Health Sciences Qatar University Doha Qatar
| | - Mazhar S Al Zoubi
- Department of Basic Medical Sciences, Faculty of Medicine Yarmouk University Irbid Jordan
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Choi J, Cho I, Kim TE, Kim HJ, Park JY, Kim CY. Obstetric factors and neonatal outcomes of depressed skull fractures in newborns. Arch Gynecol Obstet 2024; 310:673-684. [PMID: 38871966 PMCID: PMC11258088 DOI: 10.1007/s00404-024-07581-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 06/04/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE To determine the obstetric factors affecting the development of depressed skull fracture in neonates. MATERIALS AND METHODS This was a retrospectively cohort study on neonates born between July 2016 and August 2021. Neonates diagnosed with depressed skull fractures within one week of birth through X-ray and/or brain ultrasonography were included, and their mothers' obstetric characteristics were reviewed. RESULTS There were 12 cases in 6791 live births. Five women were over 35 years old. All except two were nulliparous. Five cases were delivered from labor induction and others presented with spontaneous labor. Except for two cases, delivery occurred within an hour after full cervical dilatation. Two cases were assisted by vacuum. None displayed fetal distress signs such as low Apgar scores below 7, meconium staining, and umbilical cord pH under 7.2. All depressed fractures were found in the right parietal area. Three cases resulted in focal hyperechoic lesion in brain ultrasonography and two of them showed small hemorrhage-like lesion in magnetic resonance imaging. All depressed skull fractures improved within 6 months in followed X-rays or ultrasonography. CONCLUSIONS There was no definitely associated obstetric condition for depressed skull fracture of neonates although nulliparous women were majority of the affected cases.
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Affiliation(s)
- Jihyun Choi
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Iseop Cho
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Tae Eun Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Hyeon Ji Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Jee Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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Martinez EL, Welscher A, Shah MN, Sandberg DI. Elevation of Depressed Skull Fracture in Neonates Using a Breast Pump and a Custom-Molded Flange. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01039. [PMID: 38299805 DOI: 10.1227/ons.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/27/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND AND IMPORTANCE "Ping-pong fractures" (PPF) can occur in neonates and result in cosmetic deformity and local mass effect. Standard treatment involves surgical elevation of the depressed bone when the indentation is considerable or cosmetically apparent. Surgical correction of PPF subjects patients to the risks of surgery and general anesthesia. This article and corresponding video demonstrate a novel means of correcting PPF at bedside without surgery or anesthesia. We used a hospital-grade breast pump connected to a custom-fabricated flange to successfully elevate PPF in two neonates. CLINICAL PRESENTATION Two moderately preterm infants were noted at birth to have large parietal PPF. To avoid surgical intervention, elevation using a suction device was attempted. A hospital-grade breast pump was used to provide suction. A custom device was fabricated out of a breast pump flange and molded Coloplast Brava® protective seal rings. This device was carefully applied to the skull to exactly match the diameter of the PPF and contour of the bone. Brief (15-30 seconds) periods of suction were applied several times until the PPF was successfully elevated as documented on subsequent computed tomography scans. Both infants achieved excellent cosmetic results with no adverse effects over 24- and 9-month follow-ups, respectively. DISCUSSION This technique eliminates the risks of open surgical correction and corrected the PPF without general anesthesia or adverse effects to the infant. While there may be limitations due to patient age and/or location of the PPF, the use of widely available and inexpensive custom-fitted materials with a hospital grade breast pump achieves maximal efficacy without requiring higher negative pressure suction application. CONCLUSION Elevation of PPF can be safely achieved in some neonates using readily available equipment: a hospital-grade breast pump, flange, and moldable adherent material. This technique is reasonable to attempt in lieu of surgical elevation.
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Affiliation(s)
- Emilie L Martinez
- Department of Pediatric Surgery, Division of Pediatric Neurosurgery, UT Health McGovern Medical School, Children's Memorial Hermann Hospital, Houston, Texas, USA
| | | | - Manish N Shah
- Department of Pediatric Surgery, Division of Pediatric Neurosurgery, UT Health McGovern Medical School, Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - David I Sandberg
- Department of Pediatric Surgery, Division of Pediatric Neurosurgery, UT Health McGovern Medical School, Children's Memorial Hermann Hospital, Houston, Texas, USA
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Decision-making challenge of Ping-Pong Fractures in children: systematic review of literature. World Neurosurg 2022; 165:69-80. [PMID: 35660672 DOI: 10.1016/j.wneu.2022.05.130] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 11/20/2022]
Abstract
Ping-pong fractures (PPF) have become less frequent and no definite predictors to determine which fractures will elevate spontaneously and which should undergo surgical treatment have not been clearly defined. Herein, the authors present a revision of the literature, in which 54 papers were included, with a total of 228 children studied. Patients who underwent surgery accounted for 30%; elevation through obstetrical vacuum or other aspiration systems was applied in 30%, spontaneous resolution occurred in 40%; in 4 patients percutaneous microscrew elevation was applied. Overall, in 96.4% of patients the outcome was favorable since we found no significant increase in the incidence of post-traumatic seizures or neurologic sequelae with no significant differences between treated patients and spontaneous elevation. Statistical analysis showed no significant differences among the different treatment methods (P=0.53). Our results suggest that simple compound PPFs without brain compression, hematomas or dural tears could benefit from conservative management. In cases of non-spontaneous resolution after 6 months, operative strategies should be performed, considering that there is no evidence of differences between vacuum elevation and surgical elevation.
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Popov VE, Mai RB. [Depressed skull fractures in newborns. Case report of ping-pong fracture and literature review]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:96-102. [PMID: 35170282 DOI: 10.17116/neiro20228601196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Depressed skull fractures (ping-pong) in the fetus and newborn are associated with birth canal pathology, maternal trauma and birth trauma following instrumental delivery. The authors report a newborn with a depressed skull fracture (ping-pong) who underwent minimally invasive neurosurgical lifting of bone fragment through a burr hole. Strategy and methods of treatment of similar depressed skull fractures were comprehensively discussed. Moreover, the authors proposed a brief algorithm for the use of vacuum systems and various surgical techniques, including follow-up depending on type, cause, size of the fracture and concomitant intracranial lesions.
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Affiliation(s)
- V E Popov
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - R B Mai
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
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Riethmuller D, Forey PL, Equy V, Grand S, De Schlichting E, Hoffmann P, Debillon T. [Spontaneous ping-pong fracture during vaginal delivery]. ACTA ACUST UNITED AC 2021; 49:706-708. [PMID: 33631393 DOI: 10.1016/j.gofs.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Indexed: 11/16/2022]
Affiliation(s)
- D Riethmuller
- Département de gynéco-obstétrique et médecine de la reproduction, CHU de Grenoble Alpes, Grenoble, France.
| | - P-L Forey
- Département de gynéco-obstétrique et médecine de la reproduction, CHU de Grenoble Alpes, Grenoble, France
| | - V Equy
- Département de gynéco-obstétrique et médecine de la reproduction, CHU de Grenoble Alpes, Grenoble, France
| | - S Grand
- Service de radiologie interventionnelle, CHU de Grenoble Alpes, Grenoble, France
| | - E De Schlichting
- Service de neurochirurgie, CHU de Grenoble Alpes, Grenoble, France
| | - P Hoffmann
- Département de gynéco-obstétrique et médecine de la reproduction, CHU de Grenoble Alpes, Grenoble, France
| | - T Debillon
- Service de pédiatrie, CHU de Grenoble Alpes, Grenoble, France
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Ilhan O, Bor M, Yukkaldiran P. Spontaneous resolution of a 'ping-pong' fracture at birth. BMJ Case Rep 2018; 2018:bcr-2018-226264. [PMID: 30249736 DOI: 10.1136/bcr-2018-226264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
'Ping-pong' fractures are depressed skull fractures in newborn infants that occur as inward buckling of the calvarial bones, forming a cup shape. These fractures are often associated with maintenance of bone continuity. These fractures may occur spontaneously during the intrauterine period or secondary to birth trauma. Currently, there is no standard protocol for the management of depressed skull fractures. Neurosurgical or non-surgical approaches may be administered depends on the severity of the fracture. Most untreated ping-pong fractures resolve spontaneously within 6 months. Therefore, it is recommended to reserve surgical elevation or non-surgical techniques for infants not demonstrating spontaneous resolution during this period. In addition, neurosurgical interventions are usually considered for cases with intracranial pathology or neurological deficits or for infants who do not respond to conservative treatment. Herein, we report a case of a newborn infant with a spontaneous intrauterine ping-pong fracture, which spontaneously resolved, without surgical or non-surgical intervention.
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Affiliation(s)
- Ozkan Ilhan
- Department of Neonatology, Harran University School of Medicine, Sanliurfa, Turkey
| | - Meltem Bor
- Department of Neonatology, Harran University School of Medicine, Sanliurfa, Turkey
| | - Pinar Yukkaldiran
- Department of Pediatrics, Harran University School of Medicine, Sanliurfa, Turkey
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Irland N. Case Report of Spontaneous Skull Fracture in a Newborn With Cesarean Birth for Persistent Occiput Posterior Position. Nurs Womens Health 2018; 22:250-254. [PMID: 29885713 DOI: 10.1016/j.nwh.2018.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 01/05/2018] [Accepted: 01/01/2018] [Indexed: 10/14/2022]
Abstract
Spontaneous newborn skull fracture is rarely cited in nursing literature as a potential outcome of persistent fetal occiput posterior position. Although most newborns seem unaffected by the condition initially, some may show symptoms several hours after the birth, when nursing assessments are less frequent. This case report illustrates delayed newborn symptoms that led to an unexpected diagnosis of spontaneous skull fracture.
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Spontaneous Intrauterine Depressed Skull Fractures: Report of 2 Cases Requiring Neurosurgical Intervention and Literature Review. World Neurosurg 2018; 110:256-262. [DOI: 10.1016/j.wneu.2017.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 10/06/2017] [Indexed: 11/21/2022]
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10
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Ping pong fracture in the newborn: illustration of a case. Acta Neurol Belg 2014; 114:69-70. [PMID: 23297164 DOI: 10.1007/s13760-012-0172-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
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