With the advances in neonatal and obstetric care, neonatal fractures and birth injuries are rare. In most cases, they are caused by trauma during instrumental delivery or during obstetric maneuvers in a difficult delivery [6, 8, 9]. Although associated parenchymal injuries are rare, if they occur, can have long-standing consequences.

Bhat et al. [10] in their study on neonatal fractures during delivery reported an incidence of 1 in 1000 neonates. Depressed skull fractures accounted for 11.4% of these. Dupuis et al. in their retrospective case–control analysis in France compared spontaneous and instrumental obstetric depressed skull fractures over a decade. They reported 75 cases of depressed skull fracture at an incidence of approximately 1 in every 26,000 deliveries. Of the 68 cases that were further analyzed, 18 were spontaneous and 50 were instrumental deliveries [11]. Thus, spontaneous skull fractures in neonates are not very common, and published literature on this subject is limited.

Ben-Ari et al. classified the skull depression into two types—depression without a fracture and depression with a fracture line. The difference between these types is whether the cause is related to trauma or a direct pressure effect of an external structure on the developing.

Skull. The first type has also been described as “faulty fetal packing” or congenital vault depression [12]. Some authors compared skull depressions to a ‘greenstick’ fracture found in the long bones of children [2, 11]. Another review described three types of skull fractures in newborns-linear, depressed or “ping-pong” and occipital osteodiastasis [9, 13, 14]. The parietal bones are reported to be most commonly affected followed by the frontal bones [9, 15].

There is no clear consensus on the ideal treatment modality. Previously, most ping-pong fractures in neonates were managed surgically. However, recently there has been a trend towards conservative management [13]. However, there is no definite parameter to predict which fractures will elevate spontaneously. Parental anxiety is common and cosmetic concerns may influence management [3, 7, 16].