From the Guidelines
Neonatal clavicular fractures are primarily caused by mechanical forces during the birthing process, with the most common cause being shoulder dystocia, as supported by the American College of Obstetricians and Gynecologists guidelines 1. The most significant risk factors for neonatal clavicular fractures include:
- Macrosomia (birth weight over 4000g)
- Prolonged labor
- Instrumental deliveries using forceps or vacuum extraction
- Breech presentation
- Maternal factors such as diabetes, maternal obesity, and small maternal pelvic dimensions These factors increase the risk of clavicular fracture due to the mechanical forces exerted on the infant's clavicle during delivery. According to the guidelines for skeletal survey in young children with fractures 1, clavicular fractures can occur during cesarean deliveries, though less frequently. The clavicle is particularly vulnerable to fracture in newborns because it is positioned across the narrow pelvic inlet during birth and has minimal surrounding muscle protection. Most neonatal clavicular fractures are greenstick or incomplete fractures that heal well without intervention, typically forming a callus within 7-10 days, as noted in the development of guidelines for skeletal survey in young children with fractures 1. These fractures are often considered unavoidable birth injuries rather than the result of improper obstetrical technique, occurring in approximately 0.5-3% of all vaginal deliveries. It is essential to note that the risk of clavicular fracture and brachial plexus injury is approximately 10-fold and 18-to 21-fold, respectively, when birth weight is more than 4,500g, as reported by the American College of Obstetricians and Gynecologists 1.
From the Research
Causes of Neonatal Clavicular Fracture
The causes of neonatal clavicular fracture can be attributed to several factors, including:
- Difficult deliveries, such as shoulder dystocia 2, 3
- Macrosomia, or high birth weight 4, 5
- Improper midwifery maneuvers 3
- Spontaneous vaginal delivery 5
- Prolonged second stage of labor 5
- Vertex presentation 5
- Vitamin D deficiency in mothers 5
Risk Factors
Several risk factors have been identified as contributing to the incidence of neonatal clavicular fracture, including:
- Birth weight, with higher birth weights increasing the risk of fracture 4, 5
- History of giving birth to a macrosomic infant 4
- Lower mean head-to-abdominal circumference ratio 4
- Difficult deliveries, such as those requiring forceps or vacuum extraction 6
Clinical Presentation
Neonatal clavicular fractures may present with a range of symptoms, including: