Depressed "ping pong" skull fractures in the newborns: A cohort study

Background and Aims:A ping pong fracture is a rare depressed skull fracture (DSF)observed in infants. It occurs due to the inward buckling of the calvarium, creating acup-like shape. Trauma during childbirth, particularly from instrumental delivery orthe application of pressure by physicians or midwives during challenging deliveries, isthe primary cause. This study aimed to investigate the epidemiologic characteristicsassociated with DSF in newborns and to identify the main factors related to itsincidence and the type of hematoma involved. Methods:This is a retrospective case-control analysis of all newborns delivered withDSF at King Abdulla University Hospital in Jordan between January 2008 andDecember 2020. The medical records were reviewed, and clinical data werecollected and analyzed. Results: Out of 42,955 live births delivered at King Abdulla University Hospital, 13cases of DSF were observed, giving an incidence of 3.0 in 10,000 live births. Allcases were delivered at full term. Of the 13 cases, nine cases were associated withthe use of instrumental delivery. Seven of those nine cases were delivered vaginally,while the other two cases required cesarean section following unsuccessfulinstrumental delivery. Four cases were spontaneous, with no history of trauma orinstrument use, and delivered by cesarean section. Only 3 of the 13 cases requiredneurosurgical elevation of DSF. The outcome was excellent in all cases, bothcosmetically and neurologically. Conclusion:Ping-pong skull fractures are seen in newborns infrequently in theJordanian population, with an incidence of 0.03%. Most of the cases have resultedfrom difficult deliveries though spontaneous fractures can be encountered rarely.The treatment is usually conservative with spontaneous resolution. The overallprognosis is excellent both neurologically and cosmically.