Predicting fracture occurrence and localization on neonatal clavicle fractures: A multi-centric analysis.

Background: Our objective was to identify the factors that influence the occurrence and localization of neonatal clavicle fractures and to determine which risk factor is most effective and to what extent.

Methods: A total of 66 neonates diagnosed with a neonatal clavicle fracture and a control group consisting of 850 neonates without fractures were analyzed. All patients were evaluated by the following criteria: gestational age, birth weight, gender, type of delivery, unilateral absence of the postpartum Moro reflex, maternal age at the time of delivery, number of deliveries, and presence of maternal comorbidities.

Results: The study and control groups were found to differ statistically significantly concerning gestational age, birth weight, type of delivery, and the unilateral absence of the Moro reflex (p < 0.05 for each). Vaginal delivery increased the risk of a neonatal clavicle fracture occurring by a factor of 14.27 (p < 0.001, OR = 14.27, 95% CI: 5.2-38.9). Right-sided neonatal clavicle fractures increased the risk of lateral one-third fractures by a factor of 6.2 (p = 0.037, OR = 6.2, 95% CI: 6.2-47.6).

Conclusions: The occurrence of neonatal clavicle fractures related to birth can be predicted to a certain extent, but the specific fracture levels remain difficult to ascertain. Although gestational age, birth weight, and number of deliveries of the mother are important parameters in the detection of neonatal clavicle fractures, the sole effective parameter in determining the level of the fracture is the side, and the incidence of lateral level fractures increases in right-sided clavicle fractures.

Level of evidence: Prognostic level II study.