title: Clavicle Fracture Is Not Predictive of the Need for Microsurgery in Brachial Plexus Birth Palsy.
abstract: BACKGROUND
  Brachial plexus birth palsy (BPBP) and clavicle fractures occur concurrently as well as in isolation during difficult deliveries. The concept that concurrent clavicle fracture may spare nerve injury has been advocated. Our aim was to compare those children with BPBP presenting to a tertiary care center with and without concurrent clavicle fractures and assess the utility of the presence of a clavicle fracture as a predictor of injury severity in children with BPBP.
  
  
  METHODS
  Records of all patients belonging to a large prospective multicenter cohort study of infants with BPBP (Treatment and Outcomes of Brachial Plexus Injuries study) were analyzed for demographic information and birth information including risk factors, comorbidity, presence of clavicle fracture, and injury severity.
  
  
  RESULTS
  The records of 639 children with BPBP were examined. Thirteen patients were excluded for incomplete data. Ninety-six children who sustained concurrent birth fracture and BPBP were identified (15%). Of these, 57 sustained clavicle fractures (9%), 44 sustained humerus fractures, and 4 sustained other fractures. Of the demographic factors analyzed, only the presence of gestational diabetes was found to be significantly higher in those children with fractures versus those without. The presence of a clavicle fracture did not change the rate of microsurgical intervention, nor did clavicle fracture rates differ by Toronto score, suggesting that there was no difference in injury severity between the 2 groups.
  
  
  CONCLUSIONS
  In a large multicenter prospective study, 9% of children presenting with BPBP also sustained a clavicle fracture at birth. The presence of a clavicle fracture did not correlate with the severity of brachial plexus injury. We suggest that in study populations of children with severe enough BPBP to present to a tertiary care center, compared with studies collected in the obstetric population, the presence of a clavicle fracture is neither protective from nerve injury nor predictive of injury severity.
  
  
  METHODS
  Level 2-prognostic.
authors.affiliation: Shriners Hospitals for Children-Northern California, Sacramento.
authors.forename: Holly B
authors.initials: HB
authors.lastname: Leshikar
authors.affiliation: Boston Children's Hospital, Children's Orthopaedic Surgery Foundation, Boston, MA.
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Bauer
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: Nina
authors.initials: N
authors.lastname: Lightdale-Miric
authors.affiliation: Shriners Hospitals for Children-Northern California, Sacramento.
authors.forename: Fred
authors.initials: F
authors.lastname: Molitor
authors.affiliation: Boston Children's Hospital, Children's Orthopaedic Surgery Foundation, Boston, MA.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Waters
mesh_terms: D001720:Birth Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000453:epidemiology / Q000601:surgery*; D002648:Child; D002968:Clavicle / Q000293:injuries*; D015897:Comorbidity; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D006811:Humerus / Q000293:injuries; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008866:Microsurgery; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors