*For medical professionals only
Carefully do a good job in prenatal care to reduce the occurrence of clavicle fractures.
The collarbone, commonly known as the "beauty bone", is an Elongated bone with S-shaped curvature, located under the skin, which is the boundary between the neck and the chest, and is the only bony connection between the upper limbs and the trunk, which can maintain the shoulder joint in a normal position, increase the range of motion of the upper limbs and improve labor efficiency. Large blood vessels and nerves distributed to the upper extremities pass behind the middle of the clavicle.
The collarbone plays a great role in the image and function of the person. What would happen if the baby was born and found that the keyum was broken?
Neonatal clavicle fracture is the most common type of birth fracture, sometimes the symptoms are not obvious, it is easy to be ignored by doctors or parents when you are born, the author has also encountered this phenomenon in his work, listing 3 typical cases:
Case 1: About 2 weeks after the baby was born, after the mother finished feeding, she inadvertently touched the right collarbone, felt a hard lump, and quickly touched the left side, smooth and slippery. Rushed to the hospital, X-rays showed a fracture of the right clavicle and the formation of a scab.
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Case 2: Macrosomia, refused caesarean section, delivered vaginally. Shoulder dystocia occurs during childbirth, and the mother's productivity is insufficient. After active treatment by obstetricians and midwives, the newborn is delivered. Immediately after the shoulder difficulty arises, the bilateral clavicle is examined, from the outside to the inside along the clavicle, the right side can reach the bone rubbing sensation, the child who touches the child cries, considers the fracture, and the chest X-ray confirms that the right clavicle fracture is transverse and partially overlapping.
Case 3: Full-month vaginal delivery, birth weight 3.5 kg, emergency delivery, no asphyxia. After birth, the baby sleeps less, paroxysmal crying, is not easy to soothe, cries are sharp, and easy to provoke. He was admitted to the hospital for crying reasons. An exclusionary test confirms a transverse fracture of the right clavicle with displacement.
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Parents of three babies learned about the clavicle
What are the reactions after a fracture?
Case 1: Because the scab has been formed, the baby has no special performance, and parents are worried that the baby's shoulders will be high and low when he grows up, which will affect the appearance. After being explained and reassured, go home for follow-up.
Case 2: Due to the insistence on choosing a caesarean section, the prenatal doctor repeatedly communicated the possibility of birth injury, and there was a shoulder dystocia during the delivery process, although the clavicle fracture, the family not only understood very well, but also thanked the doctor for timely treatment, and did not let the child have more serious consequences.
Case 3: After hearing that the reason why the baby has been crying since birth was caused by a fracture during the birth process, it is impossible to accept that there will be a fracture in the birth of the child, insisting that the doctor rudely broke the bone when delivering the baby, determining that it was a medical accident, insisting that the hospital compensate and being responsible for the baby's future health.
So, why do pregnant women have a fracture of the clavicle of the newborn during the delivery process, how to detect it early, how to deal with it, will it leave sequelae, whether it is a medical accident, and should it be claimed?
1
Why do neonatal clavicle fractures occur during childbirth?
Neonatal fractures are the most common birth fractures, according to the literature, the incidence of clavicle fractures in newborns in the United States is 0.4%, and the incidence rate in the mainland is about 0.46%.
The collarbone is slender and curved, and the medial 2/3 of the anterior convex and the lateral 1/3 of the posterior-upper bulge are fragile and prone to fractures. Clavicle fractures are related to birth weight, most often caused by shoulder dystocia, often in overweight, difficult to deliver babies, but can also occur in vaginal delivery and caesarean section.
The position of the fetus decreases rapidly when it is delivered, and the front shoulder blade that comes out first is squeezed into the pelvic pubic joint of the mother, and the clavicle is extremely curved and fractured. Clavicle fractures mostly occur in the center or in the middle and north of 1/3, transverse fractures, and there are displacement, and there are also incomplete fractures (green branch fractures). The chances of fractures on the left and right are similar, mostly unilateral. 5% of newborns have clavicle fractures with brachial plexus injury.
2
How can a clavicle fracture be detected early?
Symptoms of a neonatal clavicle fracture are difficult to detect, but careful observation and examination of newborns with risk factors can still reveal clues, such as:
1) The child is unwilling to move the upper arm of the affected side or is inflexible, or completely incapacitated;
2) When doing passive activities on the upper limbs of the injured side, the baby often cries, especially in the injured place, and the touch will cry more and more;
3) Touch the collarbone to find bilateral asymmetry, the affected area of the clavicle has a thickening and blurry feeling;
4) The upper limbs on both sides are inconsistent, and the upper limbs on the affected side may be painful because of pain, and the limbs are close to the chest, and the head is biased to the opposite side;
5) Local soft tissues may be swollen and tender;
6) There is a bone rubbing sensation in the early stage, and an induration can be touched in the later stage, which is the formation of a bone scab.
3
How to deal with it? Will there be any sequelae?
Fractures of the clavicle in newborns are not terrible and generally do not require special treatment. Because the neonatal bone plasticity is strong, if the position is still good, generally 7 to 9 days of periosteum and scab formation, one month can heal itself, 1 to 2 years later with the growth and development of shoulder bone widening, even if the early malformation will disappear, there is no sequelae.
4
The most sensitive question is, whether the fracture of the clavicle of the newborn is a medical accident, and does the hospital need compensation?
Medical malpractice bodies need to meet the following constituent elements:
1. The subject of medical malpractice is a legal medical institution and its medical personnel;
2. Medical institutions and their medical staff violate medical and health management laws, regulations, diagnosis and treatment nursing norms and routines;
3. The direct perpetrator of medical malpractice has subjective negligence in diagnosis and treatment;
4. The patient has personal injury consequences;
5. There is a causal relationship between medical acts and the consequences of damage.
Childbirth is an extremely complex process, whether it is a natural birth or a cesarean section, there is a possibility of neonatal birth injuries due to dystocia or surgical procedures, and clavicle fractures are the most common of birth fractures, unpredictable and unavoidable complications in childbirth.
There are many causes of clavicle fractures in newborns, the most common of which are problems with the birth canal, excessive fetal size, shoulder exposure, and abnormal fetal orientation. Of course, the unskilled operation of medical staff is also one of the reasons, but it is not the main factor.
The child's vaginal delivery, is the need for medical staff to complete, this link, the fetus's head, shoulders, abdomen and limbs need to be squeezed through the birth canal, pregnant women force at the same time, medical staff also need to assist in childbirth, so some children are born, there may be scalp hematoma, and even clavicle fracture and other situations. The alignment of the clavicle is also the lowest requirement of all fractures in the whole body, as long as the fracture can grow well next to the broken end, and it does not require how tight the alignment is, how good the anastomosis is, and there will be no sequelae.
So the production of clavicle fractures and medical malpractice in newborns is not a concept. Moreover, neonatal clavicle fractures have a good prognosis, do not require special treatment, and do not leave sequelae. The prenatal doctor will also inform you of the complications of childbirth and obtain the signature of the family. Even in developed countries such as the United States, the incidence of the disease is similar to that in China. Therefore, even if the best obstetric care is given, the occurrence of obstetric injuries cannot be avoided, and if the clavicle fracture occurs during the birth of the newborn, it is of little significance to file a lawsuit against the doctor.
How can clavicle fractures in newborns be prevented?
The prevention of neonatal clavicle fracture lies in careful prenatal care, so that obstetricians can fully grasp the situation of the fetus in the womb, including weight, head circumference and fetal position, and make appropriate judgments on the mode of production so that the incidence of birth injuries is minimized. Caesarean section in overweight giant infants can also help reduce the occurrence of clavicle fractures.
During the healing period of the baby, it is recommended that parents use the correct way to hold the baby in daily nursing, so that the baby will not be injured twice during the baby's healing process. When the baby is in severe pain, give the child analgesic or ice compresses, which are generally carried out once a day every 2 to 3 hours for 15 to 20 minutes.
bibliography:
Qiu Xiaoshan,Ye Hongmao,Shao Xiaomei. Practical Neonatology. Fifth Edition.
[2] Regulations on the Handling of Medical Malpractice (2002 Edition).
This article was first published: Pediatrics Channel of the Medical Professions
This article is written by Li Yuelan
Editor-in-Charge: CiCi