• Sung Min Cho, Moon Sung Park, Soo Han Yoon, Mi Ran Kim, Chul Hu, and Young Lu Chang.
• Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
• World Neurosurg. 2019 Jun 1; 126: e1197-e1205.

ObjectiveSkull fractures caused by birth injury are mainly compression and linear fractures, but the incidence is known to be rare. It has been recently suggested, however, that greenstick fractures (GSFs) are more common than compression or linear fractures that are detected through 3-dimensional reconstructed computed tomography. Therefore, this study was conducted to determine the correlation of GSF with perinatal factors, the accompanying head injury factors, and the long-term outcomes in neonates.MethodsA retrospective study was conducted on correlations between GSF and perinatal and head injury factors for 295 neonates. In 160 neonates, the correlation with long-term outcome was investigated.ResultsIn 295 neonates, 47 cases had 3 or fewer GSFs, 66 cases had 4-6, 82 cases had 7-9, and 100 cases had 10 or more. The number of GSFs was significantly associated with gestational age and mode of delivery among the perinatal factors, with brain swelling and cephalohematoma among the head injury factors. It was also associated with long-term outcomes. The cut-off value of the number of GSFs for a poor outcome by the area under the receiver operating characteristic curve was 6 or greater.ConclusionsIt was concluded that GSF most commonly occurs as a birth-related skull fracture and that birth-related GSF is associated with perinatal factors, birth-related head injuries, and deterioration of long-term development. Therefore, efforts should be made to prevent GSF at birth.Copyright © 2019 Elsevier Inc. All rights reserved.

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