How to manage fractured clavicle in a newborn

Mrs. BT brought her 12 –day-old baby to the hospital on Christmas day. She had noticed a swelling on the infant’s right arm which she described as painful. She could not really say the day when the bump first appeared.

The grandma who accompanied the mother and the baby to hospital said she noticed the swelling few days ago and that she had massaged it with methylsalycillate balm and the swelling had reduced.

I had reassured the mother that all would be well and explained that she needed to do an X-ray of the chest to show the extent of possible clavicle fracture.

Unfortunately, she could not get a place to do the X-ray on Christmas Day, but was done the next day. The X-ray shows a formation on the clavicle which is consistent with features of a fractured clavicle.

The clavicle is easily fractured in adults and children because of its subcutaneous, relatively anterior location and frequent exposure to transmitted forces.

The midshaft is the thinnest, least medullous area of the clavicle, and thus the most easily fractured. The lack of muscular and ligamentous support also makes it vulnerable to injury.

A fractured clavicle in a baby that has just been delivered is a broken collar bone.

Babies can easily fracture their clavicle as they pass through the birth canal during delivery. But the clavicle may be broken in newborns even after birth. In some cases, it is so mild that it is not diagnosed until the fracture begins to heal and a bump in the bone (callus) is noticed at the collarbone. In a newborn, a broken clavicle almost always heals with no problems.

Signs and symptoms

Pain, particularly with upper extremity movement or on front part of upper chest. Often, after the swelling has subsided, the fracture can be felt through the skin.

Exams and tests

A chest X-ray will show whether or not there is a broken bone.

Treatment

Generally, there is no treatment other than lifting the child gently to prevent discomfort. Occasionally, the arm on the affected side may be immobilised, most often by simply pinning the sleeve to the clothes.

The infant’s arm is put in a sling or the sleeve is pinned to his or her shirt for seven to 10 days.

After the bone has healed, a bump may remain on the clavicle over the area of the break. This bump will slowly go away over the next year or so.

Medications: Pain relievers are normally prescribed. Care givers are encouraged to follow doctors’ instructions for administering this medication to newborns. Full recovery is possible even without manipulations.

Possible complications

There are usually no complications because infants’ bones heal well. However, some healthcare providers may ask questions about how the child was injured.

Increasing pain (infants often indicate pain with crying that cannot be soothed), if a bump has still not formed over the fracture 14 days after, may suggest a non-union and the baby will need to be re- assessed by an Orthopaedic surgeon.

In conclusion, are you nursing a baby? Have you noticed anything unusual on any part of your baby’s body? Talk to a doctor today.