Clavicular fractures in neonates
P. R. Joseph and W. Rosenfeld
Department of Pediatrics, Winthrop-University Hospital, Mineola, NY 11501.
We evaluated the wide variation in the reported incidence of fractured
clavicles (0.2% to 3.5%) in newborns by screening 626 consecutive infants
delivered vaginally for fractures. One of us (P.R.J.) evaluated all
infants, twice during the initial hospital stay and 2 weeks later. Eighteen
fractured clavicles were identified for a frequency of 2.9% (18/626). One
fracture was discovered on the first hospital examination, 10 on discharge,
and 7 at follow-up. Only 2 patients had symptoms usually associated with
fractured clavicles. The most reliable clinical sign for in-hospital
diagnosis was difficulty in feeling the margins of the affected clavicle
when compared with the normal clavicle. The mean birth weight of the
infants was 3604 g (range, 3000 to 4930 g), and no obstetric complications
occurred. The reported frequency of fractures diagnosed clinically during
hospitalization significantly underestimates their occurrence. Most newborn
infants with fractures have no symptoms and minimal physical findings
during the first days of life, making repeated examination necessary.
