Risk Factors for Neonatal Clavicular Fractures: A Population-Based Case-Control Study
Assaf Kadar1, Noga Yaniv, Tal Frenkel Rutenberg
1Author Affiliations: Roth McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, London, Ontario, Canada (Dr Kadar); Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (Dr Kadar); Schneider Children's Medical Center of Israel, Petah Tiqwa, Israel (Ms Yaniv); Orthopedic Department, Rabin Medical Center, Beilinson Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr Rutenberg); Rabin Medical Center, Beilinson Hospital, Petah Tiqwa, Israel (Dr Turjeman); Orthopedic Department, Sasmon Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University, Ashdod, Israel (Dr Shemesh); Pediatric Orthopedic Unit, Schneider Children's Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr Sidon); and Clalit Health Services, Jerusalem District, affiliated with Hadassa School of Medicine, Hebrew University, Jerusalem, Israel (Dr Cohen).
Insights
Neonatal clavicular fractures are common. Risk factors include male gender, high birth weight, lower socioeconomic status, and assisted delivery, while C-section and epidural may be protective.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Care
- Pediatric Orthopedics
Background:
- Neonatal clavicular fractures are the most frequent birth injury.
- Identifying associated risk factors is crucial for prevention and management.
Purpose of the Study:
- To define risk factors for neonatal clavicular fractures.
- To analyze a large population-based dataset for epidemiological insights.
Main Methods:
- Retrospective analysis of electronic health records (2000-2020).
- Comparison of 5015 newborns with clavicular fractures against a control group.
- Inclusion of newborn, delivery, and maternal parameters in the analysis.
Main Results:
- Fracture rate of 0.28% observed.
- Significant risk factors: male gender, higher birth weight, lower socioeconomic status, maternal weight, maternal BMI, and assisted delivery.
- Protective factors: cesarean section and epidural use.
Conclusions:
- This study identifies key risk and protective factors for neonatal clavicular fractures.
- Findings are based on the largest patient cohort reported to date, offering significant clinical insights.
Background:
Neonatal clavicular fractures represent the most common fracture during delivery. We aimed to define risk factors associated with these fractures in a large population-based database.
Methods:
Data were extracted from Clalit Health Services' electronic health records from 2000 to 2020. Newborns with clavicular fractures were compared with a healthy control group. The following parameters were compared-for the newborns: sex, birth weight, birth height, and head circumference; for the delivery process: assisted delivery, cesarean section, use of epidural, birth week, and number of fetuses; and for the mother: age at delivery, socioeconomic status, height, weight, and body mass index (BMI).
Results:
We found a rate of 0.28% for neonatal clavicular fractures (5015 clavicular fractures/1 755 660 deliveries). Male gender and heavier birth weight were found to be significantly associated with clavicular fractures ( P < .001). Increased risk was also associated with lower socioeconomic status, baseline weight, and maternal BMI ( P < .001 for all). Assisted delivery increased the risk of clavicular fracture (OR = 2.274; 95% CI, 1.661-3.115; P < .0001), while cesarean section and use of epidural were found to be protective (OR = 0.149; 95% CI, 0.086-0.26; P < .0001; and OR = 0.687; 95% CI, 0.0531-0.89; P < .004, respectively).
Conclusions:
This study provides insight into the risk factors associated with neonatal clavicular fractures on the largest group of patients reported to date.
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