**7. Humerus fractures**

Fractures of the humerus are most commonly found in cases of urgent CS with the inappropriate handling of the fetus in an effort to complete the delivery and ensure proper respiration of the baby. Similar to femoral shaft fractures in the lower extremity, clinical signs are the absence of movement of the arm, angulations, oedema, and crepitus. Because of the decreased musculature of the humerus, this fracture is more easily diagnosed, as during bathing or dressing the neonate, the arm is angulating and the neonate is crying.

X-ray examination reveals the shaft fracture of the humerus **(Figures 18** and **19**). This must be differentiated from brachial plexus palsy with accurate clinical assessment. Occasionally radial nerve palsy may be found in conjunction with the neonate humerus fracture. Isolated radial nerve palsy has also been encountered in a neonate with a constriction from the umbilicus cord, without underlying fracture. It resolved gradually in a 3 weeks period [49–55] (**Figures 19** and **20**).

There are various methods for appropriate immobilization of the humerus fracture, but in case of a transverse fracture it is difficult to obtain a stable immobilization. Use of a U slab is uncomfortable and we prefer a Velpeau type of immobilization that is easily accepted and comfortable, enabling the proper breastfeeding of the neonate (**Figure 20**). It is important to achieve proper rotational alignment of the fracture since remodeling of the rotational deformities is poor. Excessive callus formation is found by the end of the 2nd week, and gradual mobilization is permitted. Humerus fractures may also present as the initial signs of metabolic disease and OI [29] (**Figure 21**).

**Figure 18.** *Fracture of the left humerus after an emergency CS delivery.*

**Figure 19***.*

*Fracture of the right humerus and treatment with appropriate strapping with Velpeau type of immobilization.*

**Figure 20.**

*An isolated left radial nerve palsy. Note the flexion of the left elbow with the shoulder movement, while the wrist and fingers are not extending.*
