Fractured Clavicle in the Newborn: Causes, Symptoms, and Treatment

Introduction:

A fractured clavicle, also known as a broken collarbone, is a relatively common birth injury that can occur during delivery. It causes limitations in the movement of arms and can result in pain and discomfort. Although it may sound alarming, fractured clavicles in newborns often heal without complications.

What Are the Causes of Fractured Clavicles in a Newborn?

Fractured clavicles in newborns typically occur during a difficult or complicated delivery. Several factors can contribute to the occurrence of this injury, including:

• Large Birth Weight: Newborns with a birth weight above the average range may have a higher risk of sustaining a fractured clavicle during delivery.

• Breech Presentation: Babies in the breech position (feet-first) during delivery are more prone to experiencing a fractured clavicle due to the increased pressure on their shoulders.

• Instrument-Assisted Delivery: The use of forceps or vacuum extractors during delivery may inadvertently lead to a fractured clavicle if excessive force is applied to the baby's shoulders.

• Difficult or Prolonged Delivery: A difficult or prolonged delivery can increase the risk of a fractured clavicle. This may occur when the baby's shoulder becomes lodged behind the mother's pelvic bone, leading to excessive pressure on the clavicle during delivery.

• Maternal Factors: Certain maternal factors may contribute to an increased risk of a fractured clavicle in a newborn. These include a narrow pelvic structure, a history of difficult deliveries, or the presence of risk factors for difficult deliveries, such as gestational diabetes or obesity.

What Are the Symptoms of a Fractured Clavicle?

Symptoms of a fractured clavicle in a newborn may include:

• Limited Arm Movement: The newborn may exhibit restricted movement in one arm or avoid moving it altogether due to pain and discomfort. They may keep the affected arm still or tucked against their body.

• Swelling or Bruising: Swelling or bruising around the area of the clavicle (collarbone) may be visible. The skin over the fractured site may appear red, swollen, or bruised.

• Pain or Discomfort: The baby may show signs of pain or discomfort when the fractured clavicle is touched or moved. They may cry or become fussy, particularly when the affected arm is manipulated or jostled.

• Grunting or Difficulty Breathing: In some cases, a fractured clavicle can cause pressure on the underlying lung tissue, leading to respiratory distress. The baby may exhibit grunting sounds, rapid breathing, or difficulty breathing.

• Uneven Shoulders: A visible asymmetry in the shoulders or the position of the arms may be noticeable. The affected shoulder may appear slightly lower or more dropped compared to the unaffected side.

How to Diagnose a Fractured Clavicle in a Newborn?

In order to diagnose a fractured clavicle (collarbone) in a newborn, healthcare providers typically perform a thorough physical examination and may order additional diagnostic tests for confirmation. The following steps are involved in the diagnostic process:

• Physical Examination: The healthcare provider will carefully assess the newborn's overall condition, paying specific attention to the area of the clavicle. Signs of swelling, bruising, or deformity will be assessed. Gentle palpation of the clavicle to evaluate for tenderness or crepitus (a grating sensation that may be felt if the bone ends are rubbing together) will be done.

• Observation of Movement: The medical professional will observe the newborn's arm movements, looking for any limitations or asymmetry. A fractured clavicle can cause restricted movement or avoidance of movement in the affected arm.

• X-ray Imaging: X-ray imaging is commonly used to confirm the diagnosis of a fractured clavicle. X-rays can provide a clear view of the clavicle and help determine the location and extent of the fracture. In some cases, additional views or angles may be required to obtain a comprehensive assessment.

How to Treat a Fractured Clavicle in a Newborn?

Treatment for a fractured clavicle in a newborn is generally conservative, focusing on pain management and promoting healing. The following measures are commonly recommended:

• Immobilization: In order to aid in healing, the baby's arm on the affected side may be immobilized using a gentle wrap or a splint. This immobilization helps stabilize the fracture site and prevents further injury.

• Pain Management: Over-the-counter pain relievers, such as Acetaminophen, may be recommended by the healthcare provider to alleviate discomfort. Caregivers should always follow the healthcare provider's instructions regarding medication dosage for newborns.

• Gentle Handling: It is important to handle the baby with care, supporting the head and neck while avoiding excessive movement of the fractured clavicle. This prevents unnecessary pain and potential complications.

What Are the Complications?

In most cases, a fractured clavicle in a newborn heals naturally within a few weeks. During this time, parents and caregivers should monitor the baby's progress and look out for any signs of infection, such as increased redness or discharge from the fractured area. Regular check-ups with the healthcare provider are typically scheduled to ensure proper healing and assess the overall well-being of the newborn.

In some instances, complications may arise during the healing process. These can include:

• Infection: Although rare, infection at the fracture site can occur. Prompt medical attention should be sought if there are any signs of infection like increased redness, warmth, swelling, tenderness, or the presence of discharge or pus.

• Abnormal Healing: In some cases, the fracture may heal with an abnormal alignment, potentially affecting the growth and development of the affected shoulder.

• Limited Range of Motion: In cases where the fracture does not heal properly, there may be a limited range of motion in the affected shoulder. This can potentially impact the baby's ability to use the arm fully or participate in certain activities as they grow older.

• Nerve or Blood Vessel Injury: There is a slight risk of nerve or blood vessel damage associated with a fractured clavicle. If nerves or blood vessels near the clavicle are affected, it can lead to symptoms such as numbness, tingling, weakness, or abnormal sensation in the arm.

Conclusion:

Fractured clavicles in newborns are a common birth injury that often heals without complications. Understanding the causes, symptoms, and treatment options associated with this condition can provide reassurance to parents and caregivers. While proper medical assessment and gentle care are essential, it is important to remember that newborns are remarkably resilient and have a high likelihood of recovering fully from this injury. By providing support, comfort, and regular follow-up care, parents and healthcare professionals can ensure the well-being of newborns with fractured clavicles, leading to a healthy and uneventful recovery.