NEWBORN CLAVICLE FRACTURES – 5 YEAR-REVIEW OF A CENTRAL HOSPITAL

Problem statement

Clavicle fractures are one of the most common birth traumatic injuries that affect neonates. These fractures may cause pain, arm mobility impairment, and brachial nerve injury (temporary or definitive), and are responsible for parents’ anxiety and concern.

Methods

All cases of clavicle fractures diagnosed and registered during the neonatal stay between 2018 and 2022, in a central Portuguese hospital, were reviewed. Statistical descriptive analysis, odds ratios (ORs) and 95% confidence intervals (95% CI) calculations were performed with SPSS-26.

Results

A total of 8132 births and 91 clavicle fractures were identified (1.12% incidence).

This incidence varied according to mode of delivery: 0.04% (1/2512) in cesarean sections and 1.65% (9/5453) in vaginal births: 1.24% (46/3715) in eutocic, 1.33% (1/75) in forceps-assisted and 2.59% (43/1663) in vacuum-assisted births. An instrumented birth doubled the chance of clavicle fractures, with an OR 2.072, 95%CI 1.365-3.145 of fractures compared to eutocic births.

Documentation by clavicle radiography was available in 78% of fractures.

96.7% of clavicle factures happened in term births. 11% of newborns weighted less than 3000g, 41.8% between 3000g and 3499g, 37.4% between 3500 and 3999g, and 9.9% of newborns weighted 4000g or more.

15.4% (14/91) of clavicle fractures were in births registered as complicated by shoulder dystocia.

Around half (49.5%) of the clavicle fractures occurred in first vaginal deliveries.

92.3% of the newborns were referred to a Neonatology follow-up appointment, although 3.3% of the infants missed it. Fifteen (16.5%) neonates had a suspicion of brachial plexus injury, but all of them regained normal arm mobility; 14 infants required physiotherapy.

Conclusion

The 1.12% incidence of clavicle fractures in our hospital is comparable to the literature. An instrumental delivery was associated with a double risk of a clavicle fracture in vaginal births. Shoulder dystocia was common among these cases. Most cases were documented by radiography and were followed-up in the Neonatology clinic; 16.5% had a suspicion of nerve injury, but no infant had a permanent lesion.