Clavicular Fracture Following Uvulectomy and Traditional Hair Barbing: A Case Report.

Activities of traditional barbers are an age-long practice in northern Nigerian. They are involved in conducting hair barbing and uvulectomy of newborn babies usually on the 7(th) day of life. This procedure is often associated with complications like bleeding, infections, but its association with clavicular fracture is a rare event which had not been reported before now. Therefore, the case of a 10-day-old Nigerian girl is highlighted. She was managed conservatively with minimal handling of the involved limb.

Introduction

Traditional hair barbing and uvelectomy is an age long practice especially in northern Nigerian culture where newborns on the 7th day of life (which coincides with day of naming ceremony) have their hair shaved and the uvula cut by the traditional barber. Families often have their designated barbers who upon receipt of news of delivery of the baby go on to perform the procedure. Their services are often patronized by both educated and noneducated parents. The barbers are also involved in circumcision and treatment of other ailments in their community.[123]

Uvulectomy is traditionally performed for infants with the perception that the uvula is responsible for throat problems including risk of suffocation during sleep.[45] Common indications include sore throat, dysphagia and chronic cough, others are vomiting, diarrhea, growth retardation and even fever.[6] This procedure is often associated with complications like infection (tetanus),[47] bleeding, and penile amputation;[89] because instruments used are often not sterilized and used on several patients in the same session. However its association with clavicular fracture is to the best of my knowledge not been reported before; therefore the case of a 10-day-old Nigerian girl who had clavicular fracture following traditional hair barbing and uvulectomy is reported.

Case Report

A 10-day-old girl presented to the pediatric emergency with complaint of excess cry, swollen left shoulder, and reduced mobility of the left upper limb which was noticed shortly after having traditional uvelectomy and hair shaving on the 7th day of life, there was no history of fever; the pregnancy and delivery were not remarkable. She was the third in the family and there was no past history of similar event in other siblings. On examination, she had a swollen left shoulder [Figure 1] with tenderness; the mobility was reduced on the left upper limb [Figure 2] with absent Moro reflex on same side. X-rays showed fracture at the posterior end of the clavicle [Figure 3]. She had orthopedic surgical review and was managed conservatively with minimal handling, sling application with pinning to the sleeve.

Figure 1

Swollen left shoulder

Figure 2

Reduced mobility of the left upper limb

Figure 3

X-rays showed fracture at the posterior end of the clavicle

Discussion

Traditional uvulectomy by traditional barbers has been an age-long practice in Nigeria and other African countries; it is also a reported practice in Saudi Arabia and some Middle Eastern countries.[10]

Clavicular fracture has been variedly reported to occur in 1.11, 1.48, and 2.9% of deliveries.[111213] It is often associated with delivery of large babies with a lower mean head-to-abdominal circumference ratio,[1113] shortened second stage of labor,[12] and often the anterior shoulder is most affected.[11] Common clinical presentation may include excessive crying especially when the limb is handled and reduced mobility of the affected limb as was observed in the index case. The clinical features may not be apparent immediately till the 3rd day after the onset of trauma;[11] but it was noticed immediately in the index case. Furthermore there may be asymmetric, depressed, or absent Moro reflex on the side of injury as was noted in this case. Clavicular fracture is often a benign trauma and due to the reparative and recuperative properties of newborn babies it often heals over time with no disability afterward.[11] The management is usually conservative with minimal handling of the involved limb.

Clavicular fracture may be associated with fragile bone diseases like osteogenesis imperfecta in which case other sites of fracture or evidence of healing will be seen. But its association with traditional barbing has not been reported before now. The mechanism in this case may be attributable to excessive restrain during the procedure. Because clavicular fracture may be subtle;[13] and for the fact that the activities of traditional barbers are mostly in villages, there is the likelihood that more cases occur unchecked. Though these fractures heal, there is need to ensure strict regulation of the activities of traditional barbers making their practice safer. Therefore traditional barbers need to be trained and educated on safe practices, such as sterilizing their equipments and to avoid harmful practices like uvelectomy; this will involve community enlightenment programs with active participation of the local community leaders otherwise it may not be acceptable to the people.

Conclusion

Clavicular fracture which before now was mostly associated with difficult deliveries is also now associated with traditional hair barbing and uvelectomy by traditional hair barber. Though a benign trauma often heals completely; there is still need to regulate their practice because they may do harm of greater magnitude if allowed unchecked.