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World Neurosurg. 2018 Jan;109:e305-e312. doi: 10.1016/j.wneu.2017.09.168. Epub 2017 Oct 5.

Reappraisal of Neonatal Greenstick Skull Fractures Caused by Birth Injuries: Comparison of 3-Dimensional Reconstructed Computed Tomography and Simple Skull Radiographs.

Author information

1
Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea.
2
Department of Radiology, Ajou University School of Medicine, Suwon, South Korea.
3
Department of Neurosurgery, Ajou University School of Medicine, Suwon, South Korea. Electronic address: ee802000@yahoo.co.kr.
4
Department of Gynecology and Obstetrics, Ajou University School of Medicine, Suwon, South Korea.
5
Department of Pediatrics, Ajou University School of Medicine, Suwon, South Korea.
6
Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, South Korea.
7
Department of Neurosurgery, Ajou University School of Medicine, Suwon, South Korea.

Abstract

OBJECTIVE:

The most common birth-associated head injuries during vaginal delivery are cephalhematomas and subgaleal hematomas. Cranial injuries are rarely encountered. The neonate cranium is soft and pliable, and greenstick skull fractures (GSFs) are expected to be more frequent than linear or depressed fractures, but they are extremely difficult to detect with simple skull radiography. As a result, no reports have been issued on this topic to date. Recent reports suggest that technological advances in 3-dimensional (3D) computed tomography (CT) have successfully enhanced the diagnostic accuracy for cranial fractures. The authors researched the types and characteristics of GSFs and the diagnostic accuracy of 3D CT for cranial fractures in neonates.

METHODS:

The simple skull radiographs and 3D CT images of 101 neonates were retrospectively evaluated and compared with respect to diagnosis of cranial fractures, and skull GSFs were classified on the basis of 3D CT findings into 5 types depending on multiplicity and location.

RESULTS:

3D CT detected 88 cases of cranial fractures, that is, 89 GSFs, 4 combined GSFs and linear fractures, and 3 combined GSFs and depressed fractures. The diagnostic rate of 3DCT was 91% and this was significantly higher than the 13% rate of simple skull radiographs (P < 0.001).

CONCLUSIONS:

GSFs rather than linear fractures were found to account for most cranial injuries among neonates. The diagnostic accuracy of 3D CT was considerably superior than simple skull radiography, but the high radiation exposure levels of 3D CT warrant the need for development of a modality with lower radiation exposure.

KEYWORDS:

3-Dimensional reconstruction; Birth injury; Computed tomogram; Neonate; Skull fracture

PMID:
28989045
DOI:
10.1016/j.wneu.2017.09.168
[Indexed for MEDLINE]

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