Clavicle Fracture

This newborn had an uncomplicated vaginal delivery, but on the initial examination, crepitus was appreciated over the left clavicle. Although a classic finding for clavicle fracture, crepitus is not always present. The examiner should have a high index of suspicion for fracture whenever the clavicle cannot be palpated easily and distinctly along the entire length of the bone. No splinting or medications are recommended; babies are typically asymptomatic. Anticipatory guidance regarding the firm lump that often develops in this area over the next few weeks (as new bone development occurs) should be given. This photo, taken 40 hours after delivery, already shows some asymmetry between the two sides.

photo by Janelle Aby, MD