Birth-Related Clavicle Fracture Management
For a newborn with a birth-related clavicle fracture, no active treatment is required—the fracture will heal spontaneously without intervention, requiring only parental reassurance and pain management with acetaminophen or ibuprofen. 1, 2, 3
Immediate Management
No Immobilization Needed
- Birth-related clavicle fractures heal without any medical intervention or immobilization devices 3
- Unlike clavicle fractures in older children and adults where slings are recommended, neonatal birth fractures do not require sling use 1, 3
- Healing occurs without residual deformity in the vast majority of cases 3
Pain Control
- Implement multimodal analgesia with weight-based dosing of acetaminophen and/or ibuprofen 2
- Pain is typically mild and self-limited in neonatal clavicle fractures 3
Diagnosis and Documentation
Clinical Recognition
- Many cases (up to 40%) remain undetected at hospital discharge 3
- Clinical suspicion should be raised by history of shoulder dystocia or physical findings including decreased arm movement, spongy feeling, or crepitus on palpation 3, 4
- Nondisplaced fractures may only become apparent after callus formation at 11-12 days of age 4, 5
Imaging Confirmation
- Confirm diagnosis with radiography when clinically suspected 3
- Understanding the radiological timeline is important: periosteal reaction appears at 7 days, callus at 11 days, bridging callus at 20 days, and remodeling at 35 days 5
Critical Documentation
- Careful documentation of any confirmed clavicle fracture is essential for medico-legal purposes 3
- Document the obstetric history, particularly any shoulder dystocia 3, 4
Skeletal Survey Considerations for Non-Accidental Trauma
The appropriateness of skeletal survey depends critically on the infant's age and trauma history:
Age 0-10 Days
- Skeletal survey is of uncertain appropriateness for infants ≤10 days old with acute clavicle fracture and no history of trauma, given the possibility of birth injury 6
Age 11-21 Days
- Skeletal survey is appropriate but not necessary for infants 11-21 days old with acute fractures 6
Age 22-30 Days and Beyond
- Skeletal survey becomes necessary for infants 22-30 days old with no history of trauma 6
- For children 1-11 months old with clavicle fractures and no history of trauma, skeletal survey is necessary to evaluate for non-accidental trauma 6, 2
Exception for Clear Trauma History
- For children 12-23 months old with a clear history of a fall, skeletal survey is not necessary 2
Parental Counseling
Reassurance Points
- Parents should be reassured that healing will occur spontaneously without intervention 3
- A prominent callus is common during healing and is a normal part of the process—parents may require specific reassurance about this finding 7
- Complete healing without residual deformity is expected 3
Warning Signs Requiring Immediate Attention
- Skin changes suggesting vascular compromise: numbness, tingling, or weakness in the arm or hand 2
- Fever or signs of infection 2
Special Consideration: When Birth Trauma is Absent
If a newborn has a clavicle fracture with no history of birth trauma, consider alternative diagnoses including malignancy, rickets, and physical abuse. 7 This is particularly important as the incidence of birth-related clavicle fractures ranges from 0.35% to 2.9% of births, meaning most newborns should not have this injury 3.