Potential risk factors for birth fractures: a case-control study

Birth fractures are uncommon but remain a concern among obstetricians. Although such fractures usually heal without long-term sequelae, some are associated with lifelong disabilities, such as brachial plexus injuries. The purpose of this study was primarily to investigate risk factors related to birth fractures.

This study comprised newborns delivered at our institute between 2003 and 2013. All 46 birth fractures were reviewed and compared with 223 randomly selected normal neonates. Demographic data of newborns and their mothers, as well as the details of delivery and fracture characteristics, were recorded. Univariate and multiple logistic regression analyses were applied to differentiate the risk factors.

Forty-six babies had birth fractures, and 223 babies were without fracture. Forty-five cases were midclavicular fractures and one was a humeral-shaft fracture. Babies with a fracture had significantly higher birthweight and length and were larger for gestational age (p ≤ 0.001 for all factors). After multivariate analysis, parameters that remained significantly correlated with higher fracture risk included nurse attendant [odds ratio (OR) 34.8, p = 0.004], large for gestational age (OR 12.1, p < 0.001), instrumented delivery (OR 10.62, p < 0.001), and meconium stain (OR 3.10, p = 0.004). A high Apgar score at one minute and cesarean delivery were associated with decreased fracture risk (OR 0.39, p = 0.004 and OR 0.12, p = 0.001, respectively).

Patient (including large for gestational age) and peripartum (including meconium stain, shoulder dystocia, instrumented delivery, and nurse attendant) factors were associated with a higher risk of birth fracture. Factors related to a decreased risk were a high Apgar score at one minute and cesarean delivery. Careful prenatal assessments are recommended to evaluate the risk of birth fracture and prompt cesarean section for patients at high risk.