Femoral shaft injuries during childbirth.

Sir,

Despite major economical and scientific growth, antepartum and postpartum care remains a major challenge in a developing country like India. This becomes more important, when we realize that 70% of our population lives in villages, where home deliveries are still being performed by untrained personnel.[1] The article by Ngom et al.[2] is thus very relevant in our context also.

Obstetrical fractures of shaft of femur though very rare are also seen in our tertiary care trauma center being referred from peripheral hospitals. Ngom et al. have described the mechanism and the treatment plan for such injuries in detail which holds true everywhere. We would like to add that strapping of thigh with the abdomen also as a treatment modality in that list because of various reasons.[3-5] First, it is an inexpensive modality and can be applied by primary health care providers in remote villages also. Secondly, it has got high acceptance by parents because it is comfortable for neonates and ensures easy care for mother. Third, outcome in terms of fracture union and deformity are comparable to any other treatment modalities.[34] This method also avoids the use of any Plaster of Paris or traction for the neonate, which may not be accessible in remote areas. In addition, Plaster of Paris casts have their own disadvantages of skin problems and compartment syndromes.

Newborns have a natural tendency to keep the hip and knee in flexed position. In case of fracture shaft of femur, when a plaster in extension is applied, it causes fracture to angulate. With strapping, the hip is flexed and the femur is splinted with the abdomen using soft adhesive dressing. This relaxes the hip flexors and helps in fracture reduction and maintaining fracture alignment. In neonates, anatomic reduction for the diaphyseal fractures is not mandatory as they have a very high remodeling rate. The aim of strapping is to adequately splint the fracture in an acceptable position for a period till the fracture is “sticky”. This strapping is usually kept for 2 weeks as the fracture becomes immobile. During this period, the bandage may need readjustment as it becomes loose. When followed up for long period, fractures managed by this method have yielded satisfactory results in terms of union, appearance, and functions.[34]