Mid Shaft Clavicular Fracture Post-SVD (Spontaneous Vaginal Delivery)
Mid shaft clavicular fractures do not occur spontaneously in adults post-SVD; this injury requires direct trauma or significant force to the shoulder region. The evidence provided addresses supraventricular tachycardia (SVT), not spontaneous vaginal delivery, but the orthopedic principles remain clear regardless.
Mechanism of Injury Required
Mid shaft clavicular fractures require a specific traumatic mechanism and cannot occur "spontaneously":
- The junction of the outer and middle third of the clavicle is the thinnest part of the bone and requires an axial load to fracture, typically from a fall on the point of the shoulder 1
- The clavicle's superficial location, thin midshaft, and forces transmitted across it make it prone to injury only when subjected to forceful trauma 2
- If there is no history of trauma in any patient presenting with a clavicle fracture, you must consider malignancy, metabolic bone disease (rickets), or physical abuse 2
Clinical Context Post-Delivery
In the postpartum period, a mid shaft clavicular fracture would require:
- Direct fall or trauma to the shoulder
- Motor vehicle accident
- Significant force application to the clavicle region
- Pathologic fracture from underlying bone disease (metastatic cancer, severe osteoporosis, hyperparathyroidism) 2
Diagnostic Approach
If a patient presents with clavicle pain post-delivery without clear trauma history:
- Obtain detailed history specifically asking about any falls, direct blows, or trauma during labor/delivery 2
- Perform radiography to confirm fracture and assess displacement 2
- If truly no trauma occurred, immediately investigate for pathologic causes including malignancy, metabolic bone disease, or infection 2
- Consider bone density evaluation and metabolic workup in the absence of trauma 2
Key Clinical Pitfall
The most critical error would be accepting "spontaneous" fracture at face value without investigating for either missed trauma or underlying pathologic process. Adult bones do not fracture spontaneously without either applied force or pathologic weakening 1, 2.