During the delivery of your newborn, injuries can sometimes occur. One of the most common forms of childbirth injury are bone fractures. A bone fracture is a type of full or partial break of a bone in the body. In newborns, the most common bones broken are the long bones which are longer than they are wide. Though it’s possible for any bone to break, a few are more common in infants than others during delivery1.
Types of Bone Fractures
The three most common types of newborn bone fractures during childbirth include the clavicle, humerus, and femur. Of these, clavicle fractures are seen more frequently than the latter two.
Clavicle
The clavicle is more commonly known as the collarbone. It functions as a support for the shoulder and protects the neurovascular bundle beneath it. During childbirth, the clavicle can fracture due to a variety of factors. Common risk factors include having a difficult vaginal delivery, including the baby being in a breech birth position or normal compression as the baby travels through the vaginal canal. Luckily, the surrounding neurovascular bundle is seldom damaged during a clavicle fracture2.
Humerus
The second most fractured bone in newborns is the humerus. The humerus is the long bone located in the upper arm. It connects the elbow joint and the shoulder and provides structural support for many muscles in the arm. In delivery, it’s not uncommon for the upper limb to rotate or hyperextend while passing through the birth canal. This can lead to the breakage of the bone due to contortion3.
Femur
As the longest long bone in the body, the femur is not typically fragile. This bone is found in the upper leg and thigh area and is meant to support the weight of the body. It connects the hip with the knee and provides stability and serves as the attachment site for many muscles. However, in the instance of a breech position in delivery that may require a cesarean section, a fracture of the femur is possible4.
Causes of Bone Fractures in Newborns
Despite fractures that occur due to natural causes, newborns may sustain preventable bone breaks due to medical negligence. Unfortunately, there are many ways that a doctor can be negligent in their practice. If injuries were preventable, it might be because your physician was neglectful in their care.
One common cause of bone fractures is prolonged labor. When there is prolonged labor, the baby may be susceptible to excess pressure around their body. This is especially common due to improper positioning, including breech positioning, that causes them to get stuck in the birth canal. If this occurs, doctors may need to use tools to aid in delivery. Such tools may include forceps. The improper use of forceps, or the incorrect or aggressive handling of the baby as they are in the birthing process, could lead to bone breaks.
One additional potentially negligent cause of newborn bone fractures is the improper use of Pitocin. Pitocin is a type of medicine that serves as intravenous oxytocin. Oxytocin is a hormone that stimulates labor contractions. If Pitocin is administered in the wrong dosage or at the wrong time during delivery, it could lead to bone fractures.
Symptoms and Prognosis of Newborn Bone Fractures
In the case that a newborn sustains a bone fracture, there are various symptoms that typically follow. First, you or the doctor might observe swelling, often significant, around the site of the break. Swelling occurs because of fluid accumulation and prevents the affected area from moving and causing further damage to the area. With this, the baby might present as not being able to move the area of the bone that is broken. For example, if the humerus is fractured you might not see much movement in the upper arm of the infant.
With bone breaks comes pain. It can often be difficult to initially recognize painful stimuli in newborns since their pain response is crying. However, if this crying is more consistent, it could signify there’s a problem, such as pain from a bone fracture, at hand.
A more recognizable sign of a bone fracture is deformity. If your baby presents with an angulated or irregular-looking bone, there is a chance that it could be broken. This occurs when the bone is broken and sticks out at an improper angle than it should, thus causing a bump or angulation of the limb.
If angulation or deformity is not present, bone breaks can often be identified with palpation during a physical examination. This is how many clavicle fractures are diagnosed. With palpation, there may be crepitus which is a crunchy feeling under the skin.
In some cases, bone breaks might not be noticeable until a day or two past birth, so it’s important to examine the newborn for signs and symptoms of bone breaks.
Prognosis for bone fractures in newborns is typically favorable. Most broken bones will heal on their own. If treatment is necessary to promote healing, they could include the use of splints or casts, administration of medication, or in severe cases, surgery.
Meet Nurse Joanne
Nurse Joanne is a licensed practical nurse (LPN) who has worked for many years in her field at several local hospitals. She spent a considerable portion of that time as an orthopedic nurse, frequently specializing in the area of surgery and wound care. As a nurse consultant, Nurse Joanne reviews medical records and provides medical summaries regarding medical conditions, care, and treatment. Nurse Joanne utilizes her vast knowledge and experience to help answer questions regarding medical conditions, treatments and test results. Ask The Nurse: 866-529-9500.
References:
- https://pubmed.ncbi.nlm.nih.gov/8002070/
- https://www.dovemed.com/diseases-conditions/fractured-clavicle-in-a-newborn/#:~:text=%28Definition%2FBackground%20Information%29%201%20A%20Fractured%20Clavicle%20in%20a,Fractures%20in%20Newborns%20occur%20during%20a%20complicated%20delivery
- https://pubmed.ncbi.nlm.nih.gov/18054670/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3400005/
- https://www.ismp-canada.org/download/safetyBulletins/2019/ISMPCSB2019-i8-Oxytocin.pdf?utm_source=safetybulletin&utm_medium=email&utm_campaign=sbv19i08#page=1
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