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.
LEVEL OF EVIDENCE: III
The occurrence of an ipsilateral clavicle fracture may improve the prognosis for recovery of a neonatal brachial plexus palsy.
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.
Corresponding author: Marybeth Ezaki, MD, Texas Scottish Rite Hospital for Children, 2222 Welborn Street 2C, Dallas, TX 75219; e-mail: Marybeth.Ezaki@tsrh.org.
Financial Disclosure The authors did not report any potential conflicts of interest.