In Reply.—We appreciate Dr Kellner's observations. Fracture of the femur usually occurs in the newborn infant during a breech delivery when the leg is pulled down after the breech is already partially fixed at the pelvic inlet, or when, during delivery of the shoulders and arms, the infant is improperly held by one thigh.1 As Dr Kellner's experience illustrates, delivery through an abdominal incision clearly does not preclude fracture of the long bones. It would be interesting to read more clinical details about the infants to whom Dr Kellner refers, including their size and the manner in which they were delivered through the abdominal incision—particularly whether any difficulty was encountered in disimpacting them from the birth canals. Obviously, fractures may result in almost any circumstance if enough force is used. We know of no studies in the medical literature on the incidence of fracture of the femur during
CLARKE TA, YOUNG LW. Neonatal Fracture and Cesarean Section-Reply. Am J Dis Child. 1982;136(9):865. doi:https://doi.org/10.1001/archpedi.1982.03970450107028
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