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 Table of Contents 
CASE REPORT
Year : 2013  |  Volume : 2  |  Issue : 4  |  Page : 390-392  

Clavicular fracture following uvulectomy and traditional hair barbing: A case report


Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria

Date of Web Publication31-Dec-2013

Correspondence Address:
Aliyu Ibrahim
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano, +234
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4863.123935

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  Abstract 

Activities of traditional barbers are an age-long practice in northern Nigerian. They are involved in conducting hair barbing and uvulectomy of newborn babies usually on the 7 th day of life. This procedure is often associated with complications like bleeding, infections, but its association with clavicular fracture is a rare event which had not been reported before now. Therefore, the case of a 10-day-old Nigerian girl is highlighted. She was managed conservatively with minimal handling of the involved limb.

Keywords: Clavicular fracture, newborn, traditional barbers, uvulectomy


How to cite this article:
Ibrahim A. Clavicular fracture following uvulectomy and traditional hair barbing: A case report. J Family Med Prim Care 2013;2:390-2

How to cite this URL:
Ibrahim A. Clavicular fracture following uvulectomy and traditional hair barbing: A case report. J Family Med Prim Care [serial online] 2013 [cited 2019 May 24];2:390-2. Available from: http://www.jfmpc.com/text.asp?2013/2/4/390/123935


  Introduction Top


Traditional hair barbing and uvelectomy is an age long practice especially in northern Nigerian culture where newborns on the 7 th day of life (which coincides with day of naming ceremony) have their hair shaved and the uvula cut by the traditional barber. Families often have their designated barbers who upon receipt of news of delivery of the baby go on to perform the procedure. Their services are often patronized by both educated and noneducated parents. The barbers are also involved in circumcision and treatment of other ailments in their community. [1],[2],[3]

Uvulectomy is traditionally performed for infants with the perception that the uvula is responsible for throat problems including risk of suffocation during sleep. [4],[5] Common indications include sore throat, dysphagia and chronic cough, others are vomiting , diarrhea, growth retardation and even fever. [6] This procedure is often associated with complications like infection (tetanus), [4],[7] bleeding, and penile amputation; [8],[9] because instruments used are often not sterilized and used on several patients in the same session. However its association with clavicular fracture is to the best of my knowledge not been reported before; therefore the case of a 10-day-old Nigerian girl who had clavicular fracture following traditional hair barbing and uvulectomy is reported.


  Case Report Top


A 10-day-old girl presented to the pediatric emergency with complaint of excess cry, swollen left shoulder, and reduced mobility of the left upper limb which was noticed shortly after having traditional uvelectomy and hair shaving on the 7 th day of life, there was no history of fever; the pregnancy and delivery were not remarkable. She was the third in the family and there was no past history of similar event in other siblings. On examination, she had a swollen left shoulder [Figure 1] with tenderness; the mobility was reduced on the left upper limb [Figure 2] with absent Moro reflex on same side. X-rays showed fracture at the posterior end of the clavicle [Figure 3]. She had orthopedic surgical review and was managed conservatively with minimal handling, sling application with pinning to the sleeve.
Figure 1: Swollen left shoulder

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Figure 2: Reduced mobility of the left upper limb

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Figure 3: X-rays showed fracture at the posterior end of the clavicle

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  Discussion Top


Traditional uvulectomy by traditional barbers has been an age-long practice in Nigeria and other African countries; it is also a reported practice in Saudi Arabia and some Middle Eastern countries. [10]

Clavicular fracture has been variedly reported to occur in 1.11, 1.48, and 2.9% of deliveries. [11],[12],[13] It is often associated with delivery of large babies with a lower mean head-to-abdominal circumference ratio, [11],[13] shortened second stage of labor, [12] and often the anterior shoulder is most affected. [11] Common clinical presentation may include excessive crying especially when the limb is handled and reduced mobility of the affected limb as was observed in the index case. The clinical features may not be apparent immediately till the 3 rd day after the onset of trauma; [11] but it was noticed immediately in the index case. Furthermore there may be asymmetric, depressed, or absent Moro reflex on the side of injury as was noted in this case. Clavicular fracture is often a benign trauma and due to the reparative and recuperative properties of newborn babies it often heals over time with no disability afterward. [11] The management is usually conservative with minimal handling of the involved limb.

Clavicular fracture may be associated with fragile bone diseases like osteogenesis imperfecta in which case other sites of fracture or evidence of healing will be seen. But its association with traditional barbing has not been reported before now. The mechanism in this case may be attributable to excessive restrain during the procedure. Because clavicular fracture may be subtle; [13] and for the fact that the activities of traditional barbers are mostly in villages, there is the likelihood that more cases occur unchecked. Though these fractures heal, there is need to ensure strict regulation of the activities of traditional barbers making their practice safer. Therefore traditional barbers need to be trained and educated on safe practices, such as sterilizing their equipments and to avoid harmful practices like uvelectomy; this will involve community enlightenment programs with active participation of the local community leaders otherwise it may not be acceptable to the people.


  Conclusion Top


Clavicular fracture which before now was mostly associated with difficult deliveries is also now associated with traditional hair barbing and uvelectomy by traditional hair barber. Though a benign trauma often heals completely; there is still need to regulate their practice because they may do harm of greater magnitude if allowed unchecked.

 
  References Top

1.Ijaduola GT. Uvulectomy in Nigeria. J Laryngol Otol 1981;95:1127-33.  Back to cited text no. 1
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2.Miles SH, Ololo H. Traditional surgeons in sub-Saharan Africa: Images from south Sudan. Int J STD AIDS 2003;14:505-8.  Back to cited text no. 2
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3.Manni JJ. Uvulectomy, a traditional surgical procedure in Tanzania. Ann Trop Med Parasitol 1984;78:49-53.  Back to cited text no. 3
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4.Prual A, Gamatie Y, Djakounda M, Huguet D. Traditional uvulectomy in Niger: A public health problem? Soc Sci Med 1994;39:1077-82.  Back to cited text no. 4
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5.Maclean U. Magical medicine: A Nigerian case report. New-York: Penguin Press; 1974.  Back to cited text no. 5
    
6.Hartley BE, Rowe-Jones J. Uvulectomy to prevent throat infections. J Laryngol Otol 1994;108:65-6.  Back to cited text no. 6
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7.Eregie CO. Uvulectomy as an epidemiological factor in neonatal tetanus mortality: Observations from a cluster survey. West Afr J Med 1994;13:56-8.  Back to cited text no. 7
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8.Adoga AA, Nimkur TL. The Traditionally amputated uvula amongst Nigerians: Still an ongoing practice. ISRN Otolaryngol 2011;2011:704924.  Back to cited text no. 8
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9.Lukong CS. Circumcision: Controversies and prospects. J Surg Tech Case Rep 2011;3:65-6.  Back to cited text no. 9
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10.Ravesloot MJ, de Vries N. A good shepherd, but with obstructive sleep apnea syndrome: Traditional uvulectomy case series and literature review. J Laryngol Otol 2011;125:982-6.  Back to cited text no. 10
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11.Hsu TY, Hung FC, Lu YJ, Ou CY, Roan CJ, Kung FT, et al. Neonatal clavicular fracture: Clinical analysis of incidence, predisposing factors, diagnosis, and outcome. Am J Perinatol 2002;19:17-21.  Back to cited text no. 11
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12.Carter G, Park JW, Tarvin C. Clavicular fractures in neonates. Am J Dis Child 1991;145:251-2.  Back to cited text no. 12
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13.Joseph PR, Rosenfeld W. Clavicular fractures in neonates. Am J Dis Child 1990;144:165-7.  Back to cited text no. 13
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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
References
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