Fractured clavicle in the newborn

Definition

A fracture of a newborn's shoulder bone (clavicle) can occur during a difficult vaginal delivery.

Causes, incidence, and risk factors

Fractured clavicle is fairly common during difficult births, particularly during a vertex (head-first) delivery or during breech (feet-first) delivery, when the baby's arms are extended above the head.

Symptoms

There is generally decreased movement of the arm on the side with the fractured clavicle. Lifting the baby under the arms causes pain. Sometimes the fracture can be felt with the fingers, but more often there is no visible or palpable evidence of abnormality.

Within a few weeks, a hard lump may develop where the bone is healing, and may be the only indication that the newborn had a fractured clavicle.

Signs and tests

The baby will not move the painful, injured arm, instead holding it still at the side. An infant's refusal to move an arm may also be due to nursemaid's elbow (a partial dislocation), nerve damage, infection, or other causes. If there is a question, a chest x-ray will show whether or not there is a fracture.

Treatment

Generally, there is no treatment other than lifting the child gently to prevent discomfort. Occasionally, the arm on the affected side may be immobilized.

Expectations (prognosis)

Full recovery occurs without treatment.

Complications

There are usually no complications. Later in life, due to the excellent healing potential of infants, it may be impossible (even by x-ray) to tell that a fracture occurred.

Calling your health care provider

Call for an appointment with your health care provider if your baby acts uncomfortable when you lift him or her.

Illustrations

Fractured clavicle (infant)

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Fractured collar bone