Clavicle Fracture Is Not Predictive of the Need for Microsurgery in Brachial Plexus Birth Palsy

on behalf of the TOBI Study Group

Research output: Contribution to journalArticle

1 Citation (Scopus)

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. LEVEL OF EVIDENCE:: Level 2—prognostic.

Original languageEnglish (US)
JournalJournal of Pediatric Orthopaedics
DOIs
StateAccepted/In press - Apr 30 2016
Externally publishedYes

Fingerprint

Clavicle
Microsurgery
Brachial Plexus
Paralysis
Parturition
Arm Injuries
Wounds and Injuries
Tertiary Care Centers
Multicenter Studies
Demography
Gestational Diabetes
Humerus
Population
Obstetrics
Comorbidity
Cohort Studies
Prospective Studies

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Clavicle Fracture Is Not Predictive of the Need for Microsurgery in Brachial Plexus Birth Palsy. / on behalf of the TOBI Study Group.

In: Journal of Pediatric Orthopaedics, 30.04.2016.

Research output: Contribution to journalArticle

@article{e0d753969e9c40a4b665f3cff5131500,
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. LEVEL OF EVIDENCE:: Level 2—prognostic.",
author = "{on behalf of the TOBI Study Group} and Leshikar, {Holly Bee} and Bauer, {Andrea S.} and Nina Lightdale-Miric and Fred Molitor and Waters, {Peter M.}",
year = "2016",
month = "4",
day = "30",
doi = "10.1097/BPO.0000000000000770",
language = "English (US)",
journal = "Journal of Pediatric Orthopaedics",
issn = "0271-6798",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Clavicle Fracture Is Not Predictive of the Need for Microsurgery in Brachial Plexus Birth Palsy

AU - on behalf of the TOBI Study Group

AU - Leshikar, Holly Bee

AU - Bauer, Andrea S.

AU - Lightdale-Miric, Nina

AU - Molitor, Fred

AU - Waters, Peter M.

PY - 2016/4/30

Y1 - 2016/4/30

N2 - 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. LEVEL OF EVIDENCE:: Level 2—prognostic.

AB - 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. LEVEL OF EVIDENCE:: Level 2—prognostic.

UR - http://www.scopus.com/inward/record.url?scp=84965049957&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84965049957&partnerID=8YFLogxK

U2 - 10.1097/BPO.0000000000000770

DO - 10.1097/BPO.0000000000000770

M3 - Article

C2 - 27137902

AN - SCOPUS:84965049957

JO - Journal of Pediatric Orthopaedics

JF - Journal of Pediatric Orthopaedics

SN - 0271-6798

ER -