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

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.