Fractured clavicle and Erb's palsy unrelated to birth trauma.

Objectives: Our purpose was to determine the perinatal factors associated with clavicular fracture or Erb's palsy in neonates and to document the percentage of cases where no risk factors were involved.

Study Design: We reviewed the medical records of all live-born singleton infants admitted to the newborn nurseries between 1992 and 1995. Mothers and infants with clavicular fracture or Erb's palsy were compared with those without these birth injuries.

Results: Of 11,636 neonates, there were 236 (2.03%) with clavicular fracture and 51 (0.44%) with Erb's palsy. Clavicular fracture was significantly associated with shoulder dystocia and high birth weight. Significant factors associated with Erb's palsy were shoulder dystocia, high birth weight, prolonged second stage, instrumental delivery, fetal distress, use of oxytocin, and epidural anesthesia. A total of 51.7% of the neonates with clavicular fracture and 29.4% of those with Erb's palsy had none of the risk factors examined.

Conclusions: Although macrosomic fetuses and instrumental or difficult deliveries are risk factors for clavicular fracture and Erb's palsy, > 50% and 25%, respectively, occur without the risk factors examined.