The bone most frequently fractured during delivery is

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2023

Obstetrics & Gynaecology

Easy

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2023

Explanation

The clavicle (collarbone) is explicitly identified in obstetric and pediatric literature as the most common bone fractured during birth.
Its incidence is approximately 5 per 1000 live births, making it a relatively frequent complication.
The fracture is often associated with difficult deliveries, particularly shoulder dystocia, where the fetal shoulder becomes impacted behind the maternal pubic bone.
Unlike other long bones, the clavicle is one of the first bones to ossify but is still delicate, making it susceptible to fracture under the compressive forces of labor.

Option A: Fractures of the radius (a forearm bone) are extremely rare during delivery.
Option C: Humeral (upper arm bone) fractures are rare compared to clavicular fractures. They are typically associated with specific, difficult delivery scenarios.
Option D: Fractures of the ulna (a forearm bone) are extremely rare during delivery.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Common neonatal birth injuries and fractures as background academic context rather than a clinical decision trigger.
A key nursing responsibility in the immediate postpartum period is the head-to-toe assessment of the newborn. Identifying a clavicle fracture early through signs like an asymmetric Moro reflex or crepitus is crucial for prompt management.
Management focuses on pain relief and immobilization. Nurses must educate parents on gentle handling techniques, how to dress the infant (affected arm first in, last out), and reassure them that the prognosis is excellent with rapid healing.
What if? If an infant with a suspected clavicle fracture also shows signs of respiratory distress, the nurse must consider a concurrent phrenic nerve injury. This is a known association with brachial plexus injuries that can accompany difficult deliveries, and it requires immediate escalation for further evaluation of diaphragmatic movement.

How to Approach the Question

First, identify the core question: It asks for the 'most frequently' fractured bone during delivery.
This is a factual recall question based on knowledge of common birth injuries.
Mentally review the common types of birth trauma. Recall that due to the mechanics of labor, especially the passage of the shoulders through the birth canal, the clavicle is under significant pressure.
Compare the likelihood of fracture for each option. The clavicle's position makes it most vulnerable. The humerus, radius, and ulna are less exposed to direct compressive forces during a typical cephalic delivery.
Select 'Clavicle' as the most statistically common and mechanistically plausible answer.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 20-39

E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 2 (pp 239-476 of 713) p. 13-15