Sir.—We read with interest the article by Joseph and Rosenfeld1 in the February 1990 issue of AJDC. We have noticed an increased occurrence of clavicular fractures in our institution during the last 6 months (12 [1.48%] of 812 newborns). We looked at different variables, including maternal age, parity, infant's weight, maternal diabetes, length of labor, oxytocin (Pitocin) induction, delivery methods, local anesthesia, episiotomy, delivery time, and delivering physician (house staff or attending staff) to find the common factor(s) in these infants.
The only common factor for seven of the affected infants was a shorter second stage of labor (mean, 11.4 minutes). In contrast to the authors' observation that only one of the 18 infants showed "classic" physical findings, we diagnosed fractures in 11 of 12 infants by the palpation of instability or crepitation over the fracture site. Roentgenography was used to confirm our clinical diagnosis. In one case,
CARTER G, PARK JW, TARVIN C. Clavicular Fractures in Neonates. Am J Dis Child. 1991;145(3):251-252. doi:10.1001/archpedi.1991.02160030015009