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Sir.—In the January radiological case of the month (Journal 1982;136:69-70), Clarke et al stated that birth trauma was an unlikely cause of the neonatal fracture of the femur because the child had been delivered by cesarean section. Although several studies show a statistical decrease in morbidity when selected infants in breech position are delivered by cesarean delivery instead of vaginally, a given infant may still suffer the same trauma. This is especially true for the very large fetuses (for example, in mothers with diabetes) and very small ones, the very groups usually chosen for abdominal delivery. At our institution, we have seen two fractured femurs and one fractured humerus during the past four years in infants in breech position delivered abdominally. Therefore, I caution radiologists and pediatricians for dismissing birth trauma as a cause of injury merely because the delivery wsa abdominal.
KELLNER KR. Neonatal Fracture and Cesarean Section. Am J Dis Child. 1982;136(9):865. doi:10.1001/archpedi.1982.03970450107027