Subscribe to RSS
DOI: 10.1055/s-0029-1234108
© Georg Thieme Verlag KG Stuttgart · New York
Spontaneous Intrauterine “Ping-Pong” Fracture: Review and Case Illustration
Publication History
received 13.03.2009
accepted after revision 16.07.2009
Publication Date:
06 October 2009 (online)
Abstract
We report a case of a closed outer-table parietal “ping-pong” skull fracture occurring in a 4 190-gram female infant born at 39 weeks and 5 days gestation after an uneventful Cesarean section (Apgar scores of 9 and 9 at one and five minutes). There was no maternal history of abdominal trauma during pregnancy and there were no complications or difficulties with Cesarean section delivery. Neurological examination was normal. Computed tomography with three-dimensional reconstruction images showed a 4 × 5 cm depression in the right parietal bone with a medial lucency consistent with a fracture of the superior margin of the skull and leftward deviation of the sagittal suture and sinus. Spontaneous resolution did not occur by one month of age and the skull fracture was repaired with excellent cosmetic results. Rarely has a case of spontaneous intrauterine skull fracture been reported in an atraumatic Cesarean delivery. We believe this fracture resulted from a chronic in utero process without associated trauma as evidenced by deviation of the sagittal suture and sinus.
Key words
“ping-pong” fracture - intrauterine skull fracture - pediatric neurosurgery
References
- 1 Abbassioun K, Amirjamshidi A, Rahimizadeh A. Spontaneous intrauterine depressed skull fractures. Child's Nerv Syst. 1986; 2 153-156
- 2 Alexander E, Davis CD. Intra-uterine fracture of the infant's skull. J Neurosurg. 1969; 30 446-454
- 3 Axton JHM, Levy LF. Congenital moulding depreoins of the skull. Brit Med J. 1965; 1 1644-1647
- 4 Ben-Ari Y. et al . Congenital depression of neonatal skull. Eur J Obstetr Gynecol Reprod Biol. 1986; 22 249-255
- 5 Garza-Mercado R. Intrauterine depressed skull fractures of the newborn. Neurosurgery. 1982; 10 694-697
- 6 Guha-Ray D. Intrauterine spontaneous depression of fetal skull: a case report and review of literature. J Reprod Med. 1976; 16 321-324
- 7 Hung K, Liao H, Huang J. Rational management of simple depressed skull fractures in infants. J Neurosurg (Pediatrics 1). 2005; 103 69-72
- 8 Jennett B, Miller JD, Braakman R. Epilepsy after nonmissile depresses skull fracture. J Neurosurg. 1974; 41 208-216
- 9 Loeser JD, Kilburn HL, Jolley T. Management of depressed skull fracture in the newborn. J Neurosurg. 1976; 44 62-64
- 10 Nakahara T, Sakoda K, Uozumi T. et al . Intrauterine depressed skull fracture. Pediatr Neurosci. 1989; 15 121-124
- 11 Raynor RG, Parsa M. Nonsurgical elevation of depressed skull fracture in an infant. J Pediatr. 1968; 72 262-264
- 12 Schrager GO. Elevation of depressed skull fracture with a breast pump. J Pediatr. 1970; 77 300-301
- 13 Steinbok P. Intrauterine depressed skull fracture. Pediatr Neurosci. 1989; 15 317
Correspondence
Dr. Herbert Fuchs
Division of Neurosurgery
Box 3272
Duke University Medical Center
Durham
North Carolina
USA
Phone: +1/919/684 3271
Fax: +1/919/684 8274
Email: fuchs001@mc.duke.edu