title: Incidence and prognosis of neonatal brachial plexus palsy with and without clavicle fractures.
abstract: OBJECTIVE
  To report the incidence of neonatal brachial plexus palsy with and without ipsilateral clavicle fracture in a population of newborns and to compare the prognosis between these subgroups.
  
  
  METHODS
  This was a retrospective review of 3,739 clavicle fractures and 1,291 brachial plexus palsies in neonates over a 24-year period from a geographically defined health care system with reference to county-wide population data.
  
  
  RESULTS
  A referral clinic for children with brachial plexus palsies evaluated 1,383 neonates, of whom 320 also had ipsilateral clavicular fracture. As a result of referral patterns within the region, it is likely that this represents nearly all infants from the area with persistent brachial plexus injury after 2 months of age. Among the children evaluated without concomitant clavicular fracture, 72% resolved spontaneously (154/214); among those with concomitant clavicular fracture, 74% healed spontaneously (55/74). Limiting the analysis to neonates delivered at Parkland Memorial Hospital and assuming that those neonates with a discharge diagnosis of brachial plexus injury with or without clavicular fracture who did not present to the referral brachial plexus injury clinic had complete resolution, 94.4% without clavicular fracture resolved and 98.1% with clavicular fracture resolved (P=.005).
  
  
  CONCLUSIONS
  The risk of persistent neurologic deficit from a birth-related brachial plexus palsy is lower than what has been reported, and the presence of a clavicle fracture may improve the likelihood of recovery.
  
  
  METHODS
  III.
authors.affiliation: Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri; and the Texas Scottish Rite Hospital for Children, and the Departments of Obstetrics & Gynecology and Pediatrics, University of Texas Southwestern Medical School, Dallas, Texas.
authors.forename: Lindley B
authors.initials: LB
authors.lastname: Wall
authors.forename: Janith K
authors.initials: JK
authors.lastname: Mills
authors.forename: Kenneth
authors.initials: K
authors.lastname: Leveno
authors.forename: Gregory
authors.initials: G
authors.lastname: Jackson
authors.forename: Lesley C
authors.initials: LC
authors.lastname: Wheeler
authors.forename: Scott N
authors.initials: SN
authors.lastname: Oishi
authors.forename: Marybeth
authors.initials: M
authors.lastname: Ezaki
mesh_terms: D001720:Birth Injuries / Q000453:epidemiology*; D020516:Brachial Plexus Neuropathies / Q000145:classification / Q000453:epidemiology*; D002968:Clavicle / Q000293:injuries*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D015599:Trauma Severity Indices