Boken collarbone in a newborn? It's not that rare

Nursing students hovered around the newborn's hospital bassinet. This particular baby was behaving himself and was not in need of special medical attention. The students simply wanted to observe a normal newborn examination as part of their labor and delivery rotation.

I began my demonstration by listening to the baby's heart, trying to capture a few quiet seconds before the baby realized he was uncovered and missing a meal. Then I proceeded with the usual head-to-toe checkup. After examining baby's eyes and mouth, I worked my way down to the shoulders, explaining that the next step was to feel the clavicles to detect any fractures. As my fingers moved over these delicate collarbones, I was surprised to feel a "crunch" at the center of one clavicle. Not nice for the little baby - though he was sure to do fine with this relatively minor problem - but certainly a good teaching example for these nursing students.

Clavicle fractures don't happen with great frequency, but I do find them in several normal newborns each year. The authors of "Rudolph's Pediatrics" textbook note that clavicular fractures occur in about 1.5 percent of all live births, with the clavicle found to be the bone most commonly fractured during the birthing process. It makes sense that, at times, a baby's broad shoulders might have a hard time coming through the narrow birth canal without something giving way.

In some cases, clavicle fractures are detected within the first few days of life when crepitus, or a crunching sensation, is felt along the baby's collarbone. In other scenarios, the fracture is not obvious on the first few newborn exams, and is instead first noted at a few weeks of life when it has already shown itself to be a nonissue and well on its way to healing. At this time, the exam reveals a hard bony knot at some point along the length of the clavicle. This knot, or callus, is a sign that the two ends of the fractured clavicle are already successfully knitting together.

Babies generally do well with fractures of the clavicle. Fracture treatment and immobilization of the affected arm is rarely necessary in these newborns, as infants heal rapidly and are not really stressing the area of fracture by using their arms in a purposeful way to reach, grab or lift objects. Other than handling the baby very gently on the side of the fracture, watching for the development of the expected healing callus formation and equal movement of both upper extremities is all that is needed.

Most older children and adolescents with clavicle fractures also heal nicely, but can be a bit more challenging for their parents and orthopedic surgeons because of their more active nature. Surgical intervention is rarely indicated in these age groups, but stabilizing the shoulders in a figure-of-eight strap or simple arm sling is often recommended.

Though treatment plans vary based on individual injuries, experts at the American Academy of Orthopaedic Surgeons note that children often need a strap or sling for up to three to four weeks following a fracture of the clavicle. Their adult counterparts can be expected to heal more slowly, in some cases requiring up to six to eight weeks in a sling.