Risk and protective factors for birth-related clavicle fracture and brachial plexus birth injury: a national cohort study

Objective Clavicle fracture is the most common birth-related fracture, resulting in concerns and dissatisfaction, while brachial plexus birth injury (BPBI) is a severe complication with potential lifelong sequelae. The study investigated how the incidence of reported clavicle fracture and BPBI has changed over time in Sweden. Design A register-based national cohort study (2010–2022). Setting The Swedish Medical Birth Register. Patients All term singleton live births in Sweden with birth-related clavicle fracture or BPBI were compared to infants without these diagnoses. Elective caesarean sections were excluded. Main outcome measures Incidence of clavicle fracture and BPBI following birth. Multivariable logistic regression was used to calculate crude and adjusted ORs with 95% CIs. Results Among 1 224 709 live births 0.23% (2796 infants) were diagnosed with a clavicle fracture and 0.13% (1630 infants) with a BPBI. During the study period, a relative decrease in incidence of 72% was observed for clavicle fracture and 44% for BPBI. Strong risk factors for clavicle fracture and BPBI were shoulder dystocia (5.23 (4.34–6.31) and 49.40 (43.40–56.22), respectively), macrosomia and vacuum extraction. The breech position was associated with BPBI but not clavicle fracture. Protective factors included caesarean delivery, occiput posterior presentation and low birth weight. Conclusion Reported birth-related clavicle fractures and BPBI are rare and decreasing in Sweden. The conditions share several maternal and obstetric risk factors, many of which are modifiable. Continued monitoring is important as obstetric guidelines, practices and population characteristics evolve.