Fracture of the clavicle in a newborn at birth

During childbirth, various injuries occur with the baby being born, among which a collarbone fracture is quite common. In this case, the integrity of the collarbone can be damaged either completely or partially. Why does this happen?

Epidemiology

A clavicle fracture is one of the most common birth injuries in newborns. [ 1 ] Statistics show that on average, there are 11-12 cases of clavicle fracture in babies per thousand births. A clavicle fracture in a newborn was found in 1.65% of all births. [ 2 ] Clavicle fractures complicated 0.05% of cesarean sections. The main risk factor associated with clavicle fracture during cesarean section was the baby's birth weight. [ 3 ]

Causes of a clavicle fracture in a newborn

The shoulders of a baby in the womb are the widest part of the body, and it is on them that the main load falls during childbirth. A collarbone fracture in a newborn occurs mainly when physical assistance is needed at the last stage of labor to push the fetus out of the mother's womb. This is done by manipulating with forceps, vacuum, pulling by the handles, and pressing on the bottom of the uterus to move the baby forward. The collarbone is vulnerable, since it is a thin and fragile tubular bone.

The most common causes of clavicle fracture are:

• the fetus exceeds the size of the woman's pelvic bone;
• rapid labor, in which the birth canal and pelvic bones are not ready for it;
• abnormal presentation of the fetus in the uterus, requiring medical intervention.

Risk factors

Risk factors for clavicle damage in newborns include insufficient qualifications of the obstetrician, as well as bone fragility, the cause of which is a genetic disorder. [ 4 ]

Pathogenesis

The pathogenesis of any fractures is associated with damage to soft tissues adjacent to the bone, tendons, nerves, and blood vessels. This increases the permeability of the capillary bed, and edema develops at the site of injury and inflammation.

Symptoms of a clavicle fracture in a newborn

Most newborns with fractures have no symptoms and minimal physical signs in the first days of life. [ 5 ] An experienced neonatologist will immediately identify the first signs indicating a clavicle fracture in a newborn. The diagnosis is indicated by:

• hematoma;
• swelling;
• baby crying while being swaddled;
• a specific crunch when palpating the affected area;
• visually detectable bone deformation;
• limited movement of the arms.

Displaced clavicle fracture in newborns

Because the clavicle is surrounded by periosteum, a connective tissue that protects the hollow bone from injury, a displaced fracture during childbirth is extremely rare. This is a more complex condition, sometimes requiring surgical treatment when the bones are in different planes relative to each other.

The child shows increased excitability, reacts very painfully to touch, there is a clear violation of the motor activity of the hand, the baby often refuses to breastfeed, a pronounced hematoma and swelling appear. In these cases, in small children, healing and regeneration of bone tissue occurs longer than usual and takes 1.5-2 months.

Complications and consequences

What is the danger of a clavicle fracture in a newborn? Consequences and complications are possible if parents underestimate the situation and ignore medical intervention. In case of a displaced fracture, the bone may not heal properly, which will cause problems in the future. A fracture in the medial third of the clavicle in a newborn can lead to the development of obstetric brachial palsy with a frequency ranging from 4 to 13%. [ 6 ] The spontaneous recovery rate of neonatal brachial plexus palsy is reported as 75–95%, but it can vary depending on the degree of injury. [ 7 ] The risk of permanent neurological deficit in birth-related brachial plexus palsy is lower than reported, and the presence of a clavicle fracture may increase the likelihood of recovery. [ 8 ]

• How long does it take for a collarbone fracture to heal in newborns?

Clavicle fractures are easy to treat because the bones of newborns are flexible and the bone tissue is soft. Complete healing takes a maximum of 3 weeks. Healing features were first observed at 7 days (periosteal reaction), 11 days (callus), 20 days (union), and 35 days (remodeling), respectively. Peak periods when each feature was present were: periosteal reaction 11-42 days, callus 12-61 days, union 22-63 days, and remodeling 49-59 days. [ 9 ]

Diagnostics of a clavicle fracture in a newborn

Most newborn clavicle fractures are diagnosed at discharge or during the first visit to a pediatric neonatologist. In addition to the doctor's examination, who, based on the criteria listed above and the results of palpation, makes a preliminary diagnosis, instrumental diagnostics - X-ray examination - will be needed for clarification. Ultrasound should be the procedure of choice when diagnosing a clavicle fracture. This is especially true in cases where impaired arm movement is the only clinical sign. [ 10 ]

Clinical suspicion of a clavicle fracture may be obtained from history (shoulder dystocia) or clinical examination (spongy or crepitus sensation on palpation).[ 11 ]

Blood, urine and other tests will help determine the general condition of the child.

Differential diagnosis

A clavicle fracture in a newborn is often difficult to diagnose because it is often asymptomatic and can also be confused with other common diagnoses such as brachial plexus palsy, congenital pseudoarthrosis, and congenital muscular torticollis. Differential diagnosis is between complete (with or without displacement) and incomplete fractures (crack). Rarely, a child may have a congenital pseudoarthrosis of the clavicle, which is difficult to distinguish from a fracture. Pseudoarthrosis classically presents as a painless lump on the clavicle, without associated tenderness or limitation of shoulder and arm motion.

Treatment of a clavicle fracture in a newborn

First aid for a broken collarbone in a newborn consists of fixing the arm, bent at the elbow, with which the broken collarbone is in contact. For this, a soft bandage is used to secure the limb to the body, a bolster is placed under the armpit. [ 12 ]

It is important to monitor the condition of the skin of the hand: if it turns blue, consult a doctor, as this is a clear sign of a blood supply disorder (the hand is squeezed too tightly). The child should not sleep on the side of the injury. It is possible to use pain-relieving ointments.

A breastfeeding mother needs to fill her diet with foods rich in vitamins, magnesium, calcium, phosphorus, silicon - minerals that help restore bone tissue. In case of severe bruises and swelling, vitamin K may be prescribed intramuscularly (usually injected for 3 days).

After the clavicle is fused, a rehabilitation period begins, including massage, magnetic therapy, electrophoresis, and special exercises. [ 13 ]

Prevention

In most cases, the prognosis is favorable, but refusal to hospitalize a newborn with a clavicle fracture in complex cases is fraught with disorders of the musculoskeletal function of the joint and the development of infection.