Commonest fracture encountered in a baby during delivery?

RML Lucknow - 2021

Obstetrics & Gynaecology

Easy

Appeared in: RML Lucknow - 2021

Explanation

The clavicle (collarbone) is the most frequently fractured bone in newborns during delivery.
Its superficial position and S-shape make it vulnerable to compression and traction forces experienced while passing through the birth canal.
Difficult deliveries, particularly those complicated by shoulder dystocia or a large-for-gestational-age infant, significantly increase the risk of this fracture.
The fracture often acts as a natural mechanism to reduce the shoulder width, allowing the rest of the body to be delivered when shoulder dystocia occurs.
Signs include crepitus over the bone, an asymmetric Moro reflex, and pseudoparalysis (decreased movement) of the arm on the affected side.

Option A: Humerus fractures are significantly less common than clavicle fractures as a birth injury.
Option C: Fractures of the ulna are extremely rare in newborns as a result of birth trauma.
Option D: Femur fractures are rare birth injuries, much less common than clavicle fractures.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain The most common type of birth-related fracture in a newborn as background academic context rather than a clinical decision trigger.
A key nursing responsibility is the thorough physical assessment of every newborn, which includes palpating the clavicles for any irregularity, crepitus, or tenderness, and observing for symmetrical arm movement and a complete Moro reflex.
Parental education and reassurance are vital. Nurses should explain that the fracture is common, heals quickly on its own, and the palpable lump (callus) that forms during healing is normal and will remodel over time.
What if? If a newborn with a suspected clavicle fracture also presents with a persistently adducted and internally rotated arm (waiter's tip posture), the nurse must suspect a concurrent brachial plexus injury (Erb's palsy). This requires immediate notification of the physician for a neurological assessment and potential referral to physical therapy.

How to Approach the Question

Identify the core of the question: it asks for the 'commonest' or most frequent fracture during birth.
Recall knowledge about common neonatal birth injuries. Birth trauma can affect various parts of the body, but some injuries are far more common than others.
Consider the anatomy and mechanics of birth. The clavicle is one of the first bones to ossify but is still delicate. It is located in the shoulder girdle, a wide point that must navigate the maternal pelvis.
Evaluate the options based on frequency. While fractures of the humerus and femur can occur, they are known to be rare and associated with specific, difficult circumstances (like breech delivery).
Conclude that the clavicle is the most likely answer due to its anatomical position and the forces exerted during delivery, especially in cases of shoulder dystocia.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 20-38

E6 Anatomy BDChaurasia V1 10e p. 41-43

E6 Osteology InderbirSingh 5e p. 34-36