A Five-year Retrospective Study on Maternal Characteristics and Neonatal Outcomes of Clavicular Fractures in the Newborns: Another Piece of Reassurance

Abstract

Objectives: To compare the maternal characteristics and neonatal outcomes of clavicular fractures in the newborns with diagnosis made in the same admission after delivery versus that made in readmission; and to provide reassurance to parents and public that clavicular fracture in the newborn is a self-limiting condition with good prognosis.
Methods: All cases of newborns with fractured clavicles in a regional hospital during a 5-year period from 1 January 2006 to 31 December 2010.
Results: A total of 188 cases of newborns with clavicular fractures were identified. The overall rate of fractured clavicles in the newborns was 0.65%. The respective rates of fractured clavicles in the newborns after instrumental deliveries and Caesarean section were 3.41% (38/1116) and 0.05% (3/6140). Overall, 68% and 90% of the cases were diagnosed in the first 3 days and within 7 days after birth, respectively; 28% of the cases were diagnosed upon readmission; 20% did not have any physical signs. In our cohort, 6.4% (12/188) of the cases were complicated with Erb’s palsy; all these recovered completely within 6 months. There was no statistically significant difference in the maternal characteristics (except use of oxytocin) between the group diagnosed in the same admission versus that diagnosed at readmission. There were statistically significant differences in the mean gestational age, mean birth weight, proportion of newborns with birth weight of 4000-4999 g, body length, Apgar score <7 at first minute, meconium-stained liquor, incidental diagnosis of fractures, physical signs of fractured clavicles, neonatal jaundice (NNJ), treatment for NNJ, sepsis, and duration of hospitalisation between the two groups. Almost all cases were assessed by orthopaedic surgeons. All cases recovered completely without any neurological deficits.
Conclusion: Clavicular fracture in the newborn is not an uncommon condition. Infants delivered by Caesarean section are not ‘immune’ to this birth trauma. The condition has good prognosis, regardless of whether the diagnosis is made in the same admission after delivery or at readmission. Parents should be reassured of the self-limiting nature of this condition.