Newborn Clavicle Fractures: Does Clavicle Fracture Morphology Affect Brachial Plexus Injury?

Abstract

Background: Newborn clavicle fractures and brachial plexus injuries (BPIs) are rare but serious perinatal complications. Methods: The aim of this study was to examine the clinical relationship between the fracture morphology (spiral, oblique, transfer) of clavicle fractures that develop during delivery in newborns and BPI. We retrospectively reviewed all perinatal clavicle fractures diagnosed at our institution over 6 years. Results: The study included 55 newborn infants with perinatal clavicle fracture. Of these, 60% (n=33) were male. Right-side clavicle fractures were present in 56.4% (n=31) and shoulder dystocia was present in 58.2% (n=32) of the patients. Of the fracture localization of the patients, 85.5% (n=47) (Allman I) and 14.5% (n=8) (Allman II) were lateral. Allman type I fractures were not associated with increased BPI (P>0.05). It was observed that 40% (n=22) of the clavicle fractures were characterized by oblique morphology, 34.5% (n=19) of the fractures by spiral morphology, and 25.5% (n=14) of the fractures by transfer morphology. In all, 41.8% (n=23) of the sample also had BPI. Of the entire sample, 40% (n=22) most frequently showed oblique morphology fractures, whereas the patient group with BPI showed spiral morphology as the most common fracture, at a rate of 52.2% (n=10). After examining the relationship between fracture morphology and BPI, the study determined a statistically significant correlation between spiral and oblique morphology fractures and the development of BPI. Conclusions: To our knowledge, our study is the first to examine the relationship between newborn clavicle fracture morphology and BPI. We think that they should be evaluated for increased BPI risk in newborn patients that have clavicle fractures with spiral and oblique morphology.

Traumatismos en neonatos que acuden al departamento de emergencias pediátricas: frecuencia, mecanismos y formas de presentación

“…Entre los factores de riesgo más frecuentes de la fractura clavicular se encuentra la macrosomía, distocia de hombros, multiparidad y partos vaginales instrumentales. Cuando la fractura se secundaria a distocia de hombro frecuentemente se acompaña de lesión del (17)(18)(19)(20) plexo braquial .…”

“…Existe un estudio que revela que las lesiones del plexo braquial que ocurrieron en ausencia de distocia de hombros tenían una tasa más (6) alta de fractura de clavícula concomitante . El tipo de fractura de la clavícula, como las oblicuas o en espiral, posiblemente predisponga a mayor frecuencia de (19) lesión del plexo braquial .…”

Management of Displaced Midshaft Clavicle Fractures in Pediatrics and Adolescents: Operative vs Nonoperative Treatment

“…The study also found a statistically significant correlation between spiral and oblique clavicle fracture morphology and development of brachial plexus injury. 25 …”