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Pediatric Rehabilitation

(Kiosk 6) Rare Occurrence of Humerus Fracture During Birth Associated with Erb's Palsy: A Case Report

Thursday, November 16, 2023
12:45 PM – 2:15 PM CT

    Primary Author(s)

  • Mihir Jani, MD

    Resident Physician
    Montefiore Medical Center/Albert Einstein College of Medicine PM&R Program
    New York, New York

    • Co-Author(s)

  • FM

    Fernando Martinez, MD

    Resident Physician
    Montefiore Medical Center/Albert Einstein College of Medicine PM&R Program
    New York, New York

Case Diagnosis: The patient was diagnosed with a mid-shaft Humerus fracture along with an Erb's Palsy of the left arm.

Case Description or Program Description: The patient was born to a 31-year-old primigravida mother. The patient's delivery was complicated by chorioamnionitis and shoulder dystocia, which resulted in a prolonged delivery. The patient’s left humerus appeared deformed and was internally rotated, with extending elbow and flexed wrist/digits. Clinically the patient diagnosed with a humerus fracture with suspicion of a radial nerve palsy or brachial plexus palsy. X rays revealed a mid-shaft humerus fracture. Gentle traction was applied, and the patient's left upper extremity was immobilized to maintain extension of the elbow.

Setting: Tertiary Medical Center

Assessment/Results: With early diagnosis and treatment, the patient's arm began to recover spontaneously. The patient was able to start a formal occupational therapy program within two weeks. At two months, the left humerus fracture had completely healed, and the patient had regained full function of the affected arm.

Discussion (relevance): Humerus fractures during birth are rare, and their occurrence with Erb's Palsy is even rarer. The most common causes of neonatal humerus fractures are complicated deliveries such as shoulder dystocia, forceps/vacuum extraction, or breech presentation. The mechanism of injury involves excessive traction on the brachial plexus during birth, which can be the reason for both injuries. Conservative management with immobilization and occupational therapy is usually sufficient, but surgical intervention may be necessary in more serious cases.

Conclusions: The case report highlights the importance of early recognition and management of humerus fractures and nerve injuries associated with birth trauma. While humerus fractures during delivery are rare, they can be associated with nerve injuries such as Erb's Palsy, which can have long-term implications for the affected child. Early diagnosis is crucial to ensure proper management and to achieve a favorable prognosis