Incidence and risk factors of clavicle, humerus fractures, and brachial plexus injuries due to birth trauma in the neonatal period.

Abstract

Objectives: This study aims to investigate the incidence and associated risk factors of clavicle and humerus fractures and brachial plexus injuries (BPIs) secondary to birth trauma.

Patients and methods: Between October 2019 and May 2023, a total of 556 newborns (300 males, 256 females; median age: 5 days; range, 0 to 5 days) with clavicle, humerus fractures, and BPIs secondary to birth trauma were retrospectively analyzed. The sex, Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores at 1 and 5 min, need for resuscitation, gestational week, mode of delivery, birth weight, birth length, and head circumference of the neonates were recorded. Concomitant BPI, evaluation specialty, and maternal characteristics were also noted.

Results: A larger head circumference was associated with an increased risk of clavicle fractures (p<0.001, odds ratio [OR]=1.681). High birth weight (p<0.01, OR=1.001), larger head circumference (p<0.001, OR=1.523), and lower APGAR score at 1 min (p=0.018, OR=0.605) were associated with BPI risk. Fractures were mainly evaluated by orthopedists, while BPI was primarily assessed by physical medicine and rehabilitation and pediatric neurology specialists (p<0.001). Neonatal physicians most frequently requested consultations from orthopedics for fractures and rehabilitation or neurology for BPI (p<0.001).

Conclusion: Our study results show that larger head circumference increases the risk of clavicle fractures and BPI. Higher birth weight and lower APGAR scores at 1 min also raise BPI incidence. Newborns with these risk factors should undergo a thorough evaluation.