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Published on: February 2, 2015
Clavicular fractures in neonates
1Department of Pediatrics, Winthrop-University Hospital, Mineola, NY 11501.
Insights
Newborn clavicle fractures are more common than previously thought, with a 2.9% incidence found in this study. Many infant fractures present with few symptoms, necessitating follow-up examinations for accurate diagnosis.
Area of Science:
- Pediatrics
- Orthopedic Surgery
- Neonatal Care
Background:
- Reported incidence of newborn clavicle fractures varies widely (0.2%–3.5%).
- Clinical diagnosis during hospitalization often underestimates fracture occurrence.
Purpose of the Study:
- To determine the actual incidence of clavicle fractures in newborns.
- To identify reliable diagnostic signs and the necessity of follow-up examinations.
Main Methods:
- Screening of 626 consecutive vaginally delivered infants for clavicle fractures.
- Multiple examinations: twice during hospitalization and a follow-up at 2 weeks.
- Clinical assessment by a single physician (P.R.J.).
Main Results:
- Identified 18 fractured clavicles, yielding an incidence of 2.9% (18/626).
- Fractures were detected at discharge (10/18) and follow-up (7/18), with only 1 detected initially.
- Only 2 infants exhibited typical fracture symptoms; difficulty palpating clavicle margins was the most reliable sign.
- Mean birth weight was 3604g; no obstetric complications were noted.
Conclusions:
- Clinical diagnosis of newborn clavicle fractures during initial hospitalization is often insufficient.
- Most infant clavicle fractures are asymptomatic, requiring repeated examinations for accurate detection.
- Follow-up assessments are crucial for identifying the true incidence of neonatal clavicle fractures.
Abstract:
We evaluated the wide variation in the reported incidence of fractured clavicles (0.2% to 3.5%) in newborns by screening 626 consecutive infants delivered vaginally for fractures. One of us (P.R.J.) evaluated all infants, twice during the initial hospital stay and 2 weeks later. Eighteen fractured clavicles were identified for a frequency of 2.9% (18/626). One fracture was discovered on the first hospital examination, 10 on discharge, and 7 at follow-up. Only 2 patients had symptoms usually associated with fractured clavicles. The most reliable clinical sign for in-hospital diagnosis was difficulty in feeling the margins of the affected clavicle when compared with the normal clavicle. The mean birth weight of the infants was 3604 g (range, 3000 to 4930 g), and no obstetric complications occurred. The reported frequency of fractures diagnosed clinically during hospitalization significantly underestimates their occurrence. Most newborn infants with fractures have no symptoms and minimal physical findings during the first days of life, making repeated examination necessary.
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