Clavicular fracture of the neonate: can it be predicted before birth?

A retrospective study of 3873 cephalic vaginal births was undertaken to evaluate which factors are associated with clavicular fractures and thereby assess their clinical relevance in antepartum prediction. Fifty-two neonates with a fractured clavicle were identified, an incidence of 1.3%. Neonates with fractures were compared to a control group without fractures. The two groups were matched for age, parity, and mode of delivery. The neonates with fractures were found to be significantly heavier than controls, with mean birthweights of 3.7 kg and 3.2 kg, respectively (p = 0.000). Significantly more newborns in the fracture group weighed more than 4 kg (p = 0.02). A similar trend was noted when birthweights of previous pregnancies were compared (p = 0.03). Fracture cases had a greater incidence of low 1-minute Apgar scores (p = 0.02), and a higher proportion of births following abnormal progress of labor (19% of fracture group and 2.9% of controls; p = 0.001). Despite these statistically significant differences between the groups, it is not possible to predict most cases of fracture before birth, since the majority of fractures occur in cases not identified by any of the studied parameters.