A clavicle fracture is a pathological condition that is characterized by a violation of the integrity of the clavicle (a tubular bone that is connected at one end to the sternum and the other to the process of the scapula).
This injury is one of the most common traumatic injuries of the musculoskeletal system in childhood. Among all fractures of the bones of the upper extremities, violation of the integrity of the clavicle accounts for about 13% of cases. About 30% of all clavicle fractures are detected in the age group from 2 to 4 years.
A fracture can be either independent (isolated) or combined with other injuries, or be part of a polytrauma.
What is birth trauma?
This is a mechanical effect that leads to disruption of the integrity of the organs and tissues of the newborn during childbirth.
The diagnosis of birth injury is made by taking into account the mother’s obstetric history, the characteristics of the course of labor, examination data and a number of additional studies of the baby (ultrasound, radiography, electroencephalography).
Childbirth traumatism has a broad classification: mechanical damage that occurs due to external negative influence, and hypoxic damage due to oxygen starvation of tissues. It can be spontaneous, or caused by the action of obstetricians and gynecologists.
If we talk about injuries, the classification is as follows:
Damage to the central nervous system (CNS) is often determined not only by mechanical impact, but also by associated acute fetal hypoxia. May be accompanied by injuries to the bones of the skull and dura mater (intracranial): • epidural hemorrhages or cephalohematomas are localized between the bone and periosteum; • subdural – between the dura and pia maters; • rupture of the tentorium cerebellum, which forms during delivery in the breech presentation; • subarachnoid hemorrhages are localized between the thin, arachnoid membrane and the cerebral hemispheres.
The most severe injury is cerebral hemorrhage. Of these, hemorrhages around the ventricles of the brain or directly into the ventricles have an unfavorable prognosis. Such injury is facilitated by the prematurity of children, the immaturity of the nervous system and its high sensitivity to hypoxia.
Damage to the peripheral nervous system The most common among them is damage to the brachial plexus, leading to partial or complete paresis of the child’s arm. Often combined with a clavicle fracture. The cause of this birth injury is the baby's shoulders getting stuck in the pelvic outlet and improper delivery by the medical staff.
Birth injury to the spinal cord of a newborn - hemorrhage into the epidural tissue and paralysis of the thoraco-abdominal diaphragm are now extremely rare. In connection with modern gentle management of childbirth.
Damage to the child's musculoskeletal system
The most common is a clavicle fracture. By applying a special bandage, a quick recovery can be achieved. Fractures of the humerus and femur are injuries from old obstetrics textbooks.
Birth trauma, which only osteopaths can see, includes a block of the occipital bone and the first 2 cervical vertebrae, subluxation of the upper cervical vertebrae. With these “hidden” minor pathologies, pronounced asymmetry of the baby’s body tone and malocclusion may develop.
Damage to a child's soft tissues
These include muscle hemorrhages and skin abrasions.
The most significant of them is hemorrhages in the sternocleidomastoid muscle, which in the future can give a picture of false torticollis.
How to treat
In your opinion, breaking a child’s collarbone is serious damage to bone tissue. But don’t despair, a child will lose a fracture much faster than it would happen to an adult. This injury is not associated with casting and does not require surgical intervention.
The applied bandage consists of swaddling a part of a limb with a soft roller inserted into the armpit, which fixes the bone in its proper place and prevents it from moving or compromising its integrity during unconscious movements of the newborn.
It is important to ensure that the bandage is not tight. This can lead to poor circulation, a visible sign of which will be the baby's blue fingers. The bandage is applied for a week. It is better to entrust the first dressing to a doctor who will show you how to do it correctly and prescribe medications that promote healing, pain relief and relieve swelling.
The elimination of hematomas is facilitated by Traumeel C ointment, which, due to its properties, has a fairly effective effect on the damage and contains natural ingredients and useful minerals. According to the manufacturers' recommendations, the drug can be used from the moment of birth and supplemented with intramuscular injections of vitamin K. This complex will not only numb the area, but also relieve inflammation.
During health restoration procedures, the baby should sleep and feed only on the healthy side.
What are the reasons?
As the fetus develops, the world in which it grew, lived and existed becomes cramped, squeezing and at a certain moment pushes, spews into the unknown. And these “doors”, that is, the birth canal, do not always open easily - this is what causes damage.
It is very difficult to predict the course of labor. Even the calmest process of the birth of a baby has an impact on its body: the body is under pressure, and it takes enormous effort to be born.
There are many prerequisites for birth trauma: a woman’s lifestyle, characteristics of pregnancy, past infections, exacerbation of diseases, fetal development abnormalities, discrepancy between the size of the baby’s head and the mother’s pelvis. Circumstances such as the tactics of medical personnel, the administration of drugs that stimulate labor, and the method of delivery are important.
Analysis of the causes of birth trauma in newborns allows us to identify 3 groups of predisposing factors . Some authors note that they are also immediate causes.
Associated with the woman’s condition: • complications of the second half of pregnancy, for example, gestosis; • pathologies of the uterus, for example, kinks, etc.; • narrow pelvis; • post-term pregnancy; • maternal age: the likelihood of complications in the form of birth trauma in babies is higher in very young mothers - up to 18 years old, as well as already “aged” - after 30 years, if we are talking about repeated births - then after 35 years; • characteristics of work and health, bad habits.
Related to the condition of the fetus: • if the fetus is not positioned correctly in utero; • if large (although this factor depends not only on it); • lack of water; • umbilical cord entanglement; • prematurity; • asphyxia during intrauterine development and childbirth; • incorrect positioning of the fetal head as it passes through the birth canal.
With the course of the birth process: • if labor is rapid or, conversely, protracted; • discoordination of uterine contractions and their features, for example, weak or, conversely, too violent; • excessive use of oxytocin in case of weak labor; • the use of obstetric forceps (which are now practically not used in obstetrics); • vacuum extraction of the fetus; • caesarean section (difficulty in removing the baby); • Kristeller's maneuver is prohibited, but is still used in obstetrics. The doctor presses on the fundus of the uterus, helping her push out the baby. But, often, it simply “squeezes out” the child.
The likelihood of fatal consequences is higher when several factors are combined.
Symptoms of injuries
A newborn, unlike an adult, has pliable bones, because some of them consist of almost half of cartilaginous tissue. What is it for? First of all, to be able to pass through the birth canal, so that the main support of the small body can withstand the loads during childbirth.
For example: the occipital bone is formed by 4 separate bones, which are connected by cartilage, and their complete fusion occurs only by the age of 7. This provides space for the baby's growing brain, as well as adaptation to changes in atmospheric pressure during childbirth, etc.
There is danger hidden in this adaptation mechanism. If something goes wrong, there is a high risk of birth injury. Every child is at risk. Symptoms depend on what kind of injury the baby received.
In case of soft tissue injury, abrasions, scratches, etc. are considered the most common. Diagnosis is carried out during a visual examination of the baby by a neonatologist. As a rule, they are not dangerous, rarely cause complications and require only local treatment. There are also more serious ones, which occur when the fetus is in an unnatural position and are accompanied by swelling and pain.
Other, more complex injuries include:
• Birth tumor – swelling with pinpoint hemorrhages in the parieto-occipital region of the head. Symptoms develop as they pass through the birth canal and disappear within 1–4 days. • Cephalohematoma – hemorrhage in the area of the skull bones. This is a dense, elastic hematoma, but painless.
In case of injury to the musculoskeletal system, the most common are injuries to the collarbone and limbs, and these problems are classified as obstetric birth trauma.
Fractures without displacement are not diagnosed immediately, but only after a while when characteristic symptoms appear: dense swelling, indicating the formation of a callus. And this is a signal for parents, a reason to visit a doctor and rule out injury.
Symptoms of displaced fractures will be: • lack of active movements; • intense, hysterical crying, which is explained by severe pain; • swelling in the area of the fracture.
With such an injury, there is a decrease in basic reflexes, depression of tone and the development of torticollis.
In case of injury to internal organs They arise as a result of a negative external impact on the fetus as a result of a pathological birth process. External signs in newborns appear only after 3 or more days; most often, hemorrhages are detected in the liver and adrenal glands. But as soon as the hematomas rupture, the following symptoms appear: • repeated vomiting; • muscle hypertonicity; • inhibition of some reflexes; • lowering blood pressure, etc.
In case of trauma to the nervous system The concept of birth injury of the spinal cord in newborns includes: hemorrhages, stretching, compression or even rupture at different levels, damage to roots, plexuses, spinal and cranial nerves. Such consequences are associated with various symptoms and are quite serious, but they directly depend on the diagnosis: • decreased muscle tone; • absence of one or more reflexes; • weak cry at birth; • unnatural act of breathing; • paresis or paralysis, etc.
For mild injuries of the central or peripheral nervous system, the prognosis is favorable, although many of them are accompanied by changes in normal muscle tone, inhibition of reflexes and basic motor reactions.
With intracranial birth trauma, for example, hemorrhages, extremely severe symptoms develop, but they depend on the location of the hematoma.
Common signs include: • sudden and sharp deterioration in the condition of children; • change in cry, sounds similar to meowing and moaning appear; • abnormal movements; • thermoregulation disorders; • suppression of reflexes, up to complete absence; • violation of the act of sucking and swallowing; • attacks of suffocation; • tremors and convulsions; • pathological regurgitation and vomiting; • anemia.
If cerebral edema or hematoma increases, death is possible.
General recommendations for recovery
For successful healing, it is necessary to fix the fracture site.
This will prevent re-injury. For successful healing of a fracture, the following general rules must be observed:
- Do not lift the limb on the injured side of the collarbone to a great height during the first 4 weeks after the injury.
- Any physical activity should be kept to a minimum; it is especially prohibited to carry heavy objects for six weeks.
- Use cold compresses regularly to relieve pain, swelling and inflammation. Apply three times a day for 15-20 minutes.
- Be sure to use an elastic bandage. When performing everyday household tasks, the hand must be completely immobilized. To do this, a light elastic bandage is regularly worn for 3-4 weeks after the injury. This will prevent re-injury and ensure a normal healing process.
- During the entire rehabilitation period, it is important to monitor your body mechanics. When using a fixation bandage, it is important to maintain the correct position of muscles and bones in order to avoid curvature and the development of pathologies in the future.
You should visit your doctor regularly, as well as your physical therapy office. With caution and without enthusiasm, you can perform therapeutic exercises with a gradual increase in loads.
Hidden symptoms
With complex and serious birth injuries, the symptoms are more than obvious, and there are no problems with diagnosis. But there are also hidden symptoms, when they appear you need to enlist the support of a good specialist and begin treatment.
Doctors at the Quality of Life clinic will help not only to promptly recognize birth trauma, but will also prescribe comprehensive treatment for newborns, which will help get rid of the consequences without complications, and in most cases, medications. But the main thing is a timely visit to an osteopath.
Signs of a hidden birth injury will be: • crying that appears when lying on your back, for example, during sleep, changing a diaper, etc.; • the baby categorically refuses to lie on his stomach, and attempts to raise his head are accompanied by crying; • does not hold his head in an upright position by 1.5 months; • it seems that the neck is pulled into the shoulders; • the baby throws his head back while lying on his back; • the child's head is tilted to one side and the hair is not worn in the middle of the back of the head; • the baby falls asleep only with his head buried in the hard side of the bed; • symptoms of intestinal colic are prolonged; • frequent and profuse regurgitation (literally like a fountain), monthly weight gain is not normal; • the large fontanel closes quickly; • there are signs of psychomotor development disorders; • if during a complex of revival (reaction to communication) one side of the body noticeably predominates in movement, for example, the right arm and leg are more active in comparison with the left, or the legs move actively, but the arms do not. • does not take the breast well, sucking activity is reduced, which affects weight gain, as well as the condition of the mother’s breasts (cracked nipples, etc.).
Doctors at the Quality of Life clinic remind us that the first year of children’s lives is the most important; it is during this time that health is created. And almost anything can be fixed, sometimes without drugs.
Diagnosis of a fracture
X-rays are not recommended for newborns, but they are necessary in case of a fracture. Don't worry too much about this. Radiation doses are selected very carefully to minimize potential harm. If you treat a baby without such an examination, the likelihood of improper bone fusion increases.
The only problem that can be encountered during an x-ray examination is that it is problematic to immobilize the baby. The study is carried out during sleep or under the influence of special drugs. Based on the images taken, the doctor selects the appropriate treatment tactics. Pediatric traumatologists often encounter similar injuries, so there is no need to doubt their competence.
Consequences of birth trauma
The consequences and complications of injuries can be more than serious: severe neurological disorders (cerebral palsy), mental retardation, and in complex cases, disability and even death can occur.
By the way, the early signs of cerebral palsy will be: hypotonicity of the muscles, the baby does not hold his head up, and practically does not roar; by 1.5 months, the grasping reflex and the revival complex are absent.
Doctors at the Quality of Life clinic understand well that all emerging diseases are not spontaneous. In the overwhelming majority of cases, they are natural stages in the development of a single pathological process, which begins in newborns and is often associated with birth trauma.
These initial deformations gradually take root, leading to even greater problems that only get worse over time.
The consequences of birth trauma also affect psychological health, and this is where fears, complexes, depression and anxiety are formed. Therefore, only by taking timely measures, visiting a doctor who can identify non-obvious symptoms that hide the injury, and starting a complex of treatment, can you overcome the consequences of birth trauma and ensure a healthy life for your children.
Procedures and care for a child during the rehabilitation period
During the recovery period, it is necessary to strictly follow the recommendations of specialists. In the first week after the injury, decongestants may be prescribed for the hematoma (administration of vitamins K), if there is one. The consequences of the bone coming out of the joint pass faster than with a fracture, however, even such an injury in newborns heals within 7-10 days, if there are no complications. The rehabilitation period may take about 30 days.
READ ALSO: natal birth injury of the cervical spine in a newborn
After the bone has healed, procedures may be prescribed to restore mobility, such as massage and exercise therapy. In some cases, electrophoresis or magnetic therapy is used. Sometimes the attending physician may prescribe vitamins (calcium, magnesium, phosphorus) or recommend adding foods rich in these elements to the mother’s diet (for breastfeeding).
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Treatment tactics
Eliminating the consequences of birth trauma always requires an integrated approach. If we are talking about complex injuries, then in addition to drug therapy, possibly surgical treatment, the care and love of parents, the work of an osteopath, physical therapy methods, manual techniques and massage play a big role.
In case of birth injuries, the main task of the osteopath is to normalize the “breathing” and “nutrition” of the brain, which is carried out by “releasing” the sutures of the skull, as well as the connection of the occipital bone and the first cervical vertebra. When working with soft osteopathic techniques, metabolic processes and blood supply are normalized, which ensures “breathing” and “nutrition” of the brain.
The sooner the baby is in the “seeing” hands of an osteopath, the greater the likelihood that the consequences will be reversed. And with active treatment, it will be possible to at least smooth out the consequences.
Treatment of birth trauma by an osteopath allows you to restore the position of the skull bones, and this effect is without pain, stress and “twisting”, but most importantly, it is possible to avoid taking medications. After all, the body has reserve forces for self-healing; the main thing is to set the vector of movement. An integrated approach involves the participation of a movement specialist – a physical therapy doctor. Depending on the type of birth injury received and the condition of the toddler, an individual set of exercises is developed and techniques are selected: Vojta therapy, activation of the motor zones of the brain, through reflexogenic zones of the body, etc.
Prevention and prognosis for trauma
The prognosis directly depends on the type of birth injury received, its severity and, of course, the measures taken.
It is possible to completely avoid the consequences of injuries in 70-80% of cases, but only with timely treatment. Although echoes are possible: anxiety, headaches, poor sleep, prolonged colic.
In case of serious injuries in combination with late provision of assistance, or if it turns out to be unqualified, then more serious consequences are possible: cerebral palsy, epilepsy, developmental delays of varying severity, etc.
If we talk about preventive measures, these include: • competent management of pregnancy; • assessment of factors that can lead to injury: related to intrauterine development of the fetus, maternal history; • formation of a serious attitude of the mother towards pregnancy; • caring attitude towards mothers and children during childbirth, prevention of unnecessary obstetric intervention and refusal of caesarean section without indications; • examination of the baby to exclude possible injury and careful attention to developing symptoms over time.
Birth trauma can come back to haunt you after a period of time - months or even years - and can remain with you for the rest of your life. But you need to choose a specialist carefully and with all seriousness, because the health and full life of the baby depends on the actions of the doctor.
At the Quality of Life clinic, appointments are conducted by specialists with many years of experience in osteopathy, physical therapy and, of course, working with children. An integrated approach is a guarantee of success and absence of complications.
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