Case Overview: 44 year old mother [G:1 P:0] who weighed 126 pounds and whose height was 5′ 3″ was admitted to hospital on 11/2/08 @ 2:34PM. Her membranes ruptured at 4:30PM. Complete cervical dilation at 8:15 pm. Delivery of infant at 10:48PM. Total of 8 hours / 14 minutes labor. Vertex presentation. Position ROA. Vacuum extraction. Child 8 pounds 10 ounces, female, 20 inches.

During birth process the parents report that the child’s head became “stuck”. Doctor pulled hard [according to parents] and suction on the vacuum was lost due to blood/fluids. Doctor seemed nervous according to parents. An epidural was in progress during delivery. In hospital delivery records a “bruise” was noted at the clavicle. Following the delivery the parents noticed a “lump” at the clavicle area. Post discharge from hospital: X-ray examination on 11/13/08 demonstrated a fracture at the junction of the proximal two thirds and distal one third with inferior angulation of the distal fragment.

EXPERT RESPONSES

This is not a case. Clavicle fractures occur not infrequently for no particular reason known. One of the maneuvers sometimes employed to overcome a shoulder dystocia is an attempt at breaking the clavicle. One could even surmise in this case that if the clavicle was not fractured there would have been a shoulder dystocia and a potential Erb’s palsy, a far far worse injury than a fractured clavicle. The clavicle will heal without any permanent impairment. Even if there was negligence the injury in this case is minimal with no permanency. – Dr VB

Fractured clavicles can occur in uncomplicated spontaneous deliveries as well as difficult ones. If the infant has no other problems there would be no negligence. – Dr RL

The fracture of the clavicle is a known complication of a shoulder dystocia and is not considered below the standard of care. – Dr DP