Birth trauma can lead to fracture of the clavicle. Fortunately, the fractured clavicle seldom leads to long-term sequelae. In order to avoid exposure to radiation, this study attempted to confirm the diagnosis using ultrasound.
Fifteen infants underwent ultrasound after clinical suspicion of a clavicle fracture. Real time ultrasound was performed using a standard ultrasonographic machine and a small, 7.5MHz linear array transducer. Discontinuity, step offs or actual deviation, periosteal elevation, hematomas, and soft tissue changes were recorded. Both shoulders were examined and no sedation was utilized. Reexamination was then performed 6 weeks later by clinical examination and repeat ultrasound. All fifteen patients had a confirmed diagnosis of clavicle fractures and all were unilateral. There were no instances of commitment brachial plexus birth palsy. All fractures healed without complications.
Fractures of the clavicle have been reported in 0.2% to 10% of deliveries. In this study, the incidence was 0.5%. Wrist factors include a birth weight greater than 4500gm, a birth length of more than 52cm, and shoulder dystocia. This study indicates that ultrasound examination is a method for confirming a suspected clavicle fracture in the neonate. Hematomas represent an indirect sign of fracture, while bony interruption and visible periosteal lesions are more confirmatory. Ultrasound determination was found to be reliable and satisfactory and a satisfactory alternative to plain x-rays.
J Bone Joint Surg