A Fractures to the long bones are a common finding when there is a history of a difficult delivery.

[Feedback :- Considerable force is required to fracture a long bone, and if they are found at birth this suggests osteogenesis imperfecta. If they occur on the NICU there is often a background of severe osteopenia of prematurity or vitamin D deficiency.]

B Skull fractures found immediately after delivery indicate medical negligence has occurred.

[Feedback :- They may occur spontaneously in difficult or obstructed labour, or with genetic forms of metabolic bone disease.]

C Rib fractures are rarely caused by CPR in full-term infants, and the possibility of non-accidental injury should be considered.

This is the Correct Answer

[Feedback :- The rib cage is flexible and not fully ossified. If a baby has been home and re-presents with rib fractures, non-accidental injury should be considered, even if CPR has taken place. In preterm babies on the NICU with severe osteopenia, rib fractures may occur after chest physiotherapy or CPR, but the bones are usually obviously osteopenic.]

D Fractures to the humerus or femur will require surgical stabilization to prevent future deformity.

[Feedback :- Even severe long bone fractures heal remarkably well in preterm and newborn infants due to the rapid bone growth and remodelling that occurs. If the ends of the bone are displaced, simple cast splinting may be required. This may also prevent pain.]

E Fractures to the clavicle can cause an Erb's palsy.

[Feedback :- A fractured clavicle may be associated with Erb's palsy, for example after severe shoulder dystocia, but it is not causative, the palsy being due to nerve root injury near the spinal cord.]