Related Experiment Video
Updated: Sep 30, 2026
Development of a Neonatal Rat Model for Brachial Plexus Birth Injury
Published on: March 27, 2026
Reappraisal of neonatal clavicular fracture: relationship between infant size and neonatal morbidity
Man-Ho Lam1, Grace Y Wong, Terence T Lao
1Department of Obstetrics and Gynecology, Tsan Yuk Hospital, Hong Kong SAR, Republic of China. f1592821@netvigator.com
Insights
Neonatal clavicular fracture is uncommon after vaginal birth and has little clinical significance. It is not a reliable indicator of the quality of obstetric care provided.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Pediatric Orthopedics
Background:
- Clavicular fractures occur in 1.6% of vaginal births.
- Associated with instrumental delivery and shoulder dystocia.
Purpose of the Study:
- To examine neonatal morbidity associated with clavicular fractures.
- To investigate the relationship between infant size and morbidity in these newborns.
Main Methods:
- Retrospective case-control study of vaginally born infants with clavicular fractures.
- Matched controls selected based on gestational age, birth weight, and delivery time.
- Neonatal outcomes compared, with morbidity analyzed by infant size (large for gestational age vs. not).
Main Results:
- Clavicular fractures linked to increased instrumental delivery and shoulder dystocia.
- Erb palsy more common in large for gestational age infants; cephalhematoma in non-large for gestational age infants.
- Multivariable analysis indicated clavicular fracture was not a significant independent factor for these outcomes.
Conclusions:
- Neonatal clavicular fracture has minimal clinical significance.
- Fracture does not reflect the quality of care.
- Further research may be needed to fully understand associated morbidities.
Objective:
To examine the extent of neonatal morbidity and its relation with infant size in newborns diagnosed with clavicular fracture after vaginal birth.
Methods:
A retrospective case-control study was performed on all the infants diagnosed with clavicular fractures and born vaginally between July 1997 and June 2000. For each index case, a control matched for gestational age (within l week), birth weight (within 100 g), and delivered within the same 24-hour period (8 AM to 8 AM), was selected at random from the delivery suite registry. If a control could not be identified within the period, the search was extended to the previous or the following 24-hour period, and the birth weight criterion relaxed to within 250 g. The overall neonatal outcome was compared between the two groups and the morbidity was further analyzed according to whether the infants were large for gestational age (LGA) or not.
Results:
Clavicular fracture, found in 1.6% (151 of 9540) of vaginal births, was associated with increased incidence of instrumental delivery (P =.001) and shoulder dystocia (P =.013). The associated morbidity were Erb palsy (P =.007), which was more often found in the LGA infants (P =.055), and cephalhematoma (P =.031), which was only found in the non-LGA infants (odds ratio 4.48, 95% confidence interval 1.23, 16.30). On multivariable analysis, clavicular fracture was excluded as a significant factor in these outcomes after adjusting for the effect of instrumental delivery and shoulder dystocia.
Conclusion:
Neonatal clavicular fracture is of little clinical significance, and it does not reflect quality of care.
