Clavicle fractures in the pediatric population are very common. Clinical manifestations include decreased movement of the arm on the affected side, crepitus, and/or bony irregularity at the fracture site. In neonates, the Moro reflex may be absent on the affected side.
Perinatal fractures have been reported to occur in 0.2% to 5% of newborns.1-5 A high birth weight and difficult vaginal delivery--especially with the shoulder in the vertex presentation and extended arms in a breech delivery--may put a neonate at increased risk for fracture of the clavicle. However, such fractures can also occur when a baby is of average weight and the delivery is not complicated.
The presence of a clavicle fracture in a neonate does not signal an underlying pathologic process. If other fractured bones of the arms, legs, skull, and ribs are present, osteogenesis imperfecta is a likely diagnosis: other characteristics of this disorder include the presence of wide sutures, wormian bones, blue sclerae, and a family history of frequent bone breakage. In a child with multiple fractures, child abuse is also suggested.
The vast majority of perinatal clavicle fractures heal completely without intervention. The radiograph displays callus formation that had developed by the time the child was a few weeks old (Case 1). In the rare child with an associated brachial plexus injury, close monitoring is required along with management by a physical therapist and, possibly, by a pediatric neurologist and/or neurosurgeon.