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Neonatal clavicle fracture

Case contributed by Derrick Chansiongpen
Diagnosis certain

Presentation

Born via normal spontaneous delivery at 39 weeks and 4 days age of gestation from a mother with gestational diabetes and with delivery history of shoulder dystocia. Fetal birth weight at delivery is 3440 grams.

Patient Data

Age: Neonate
Gender: Male

Bedside AP XR of the Chest

x-ray

The lungs are slightly hyperaerated without focal lung opacities. Mild prominence of the interstitial markings are appreciated. 

The cardiothymic shadow is within normal limits. Hemidiaphragms and sulci are intact. 

There is a complete fracture in the right mid clavicle. 

Case Discussion

Multiple maneuvers have been designed to cope with shoulder dystocia during delivery such as intentional clavicular fractures aimed at shortening the biacromial diameter. However, clavicular fractures may occur as a complication in addition to humeral fractures, hypoxic-ischemic encephalopathy, and brachial plexus injury (Erb palsy)

Clavicular fractures may be complete or incomplete and may occur in one or both sides. Incidence increases with increased fetal weight (4000 grams or higher). Although it occurs more often during vaginal deliveries, cases of clavicular fractures from Cesarean deliveries have been reported.

The plain radiograph remains the mainstay / initial imaging tool to evaluate clavicular fractures, particularly during the immediate post-delivery period.

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