Broken Bones and Fractures During Birth

When a baby sustains a fracture during delivery, parents face an immediate flood of questions and concerns. While these injuries can feel overwhelming in the moment, understanding what happened, why it occurred, and what to expect moving forward can provide some reassurance during a stressful time.

Birth-related fractures are among the most well-documented delivery complications. Though they remain relatively uncommon overall, certain types occur with enough frequency that medical teams are well-prepared to recognize and treat them.

How Common Are Fractures During Birth

The likelihood of a newborn sustaining a fracture during delivery varies considerably depending on the type of bone involved and the specific circumstances of the birth.

Clavicle fractures stand out as the most frequently occurring birth-related broken bone, affecting anywhere from 1 to 15 babies per 1,000 live births. This wide range reflects differences in detection methods and delivery circumstances, but even at the higher end, most deliveries proceed without incident.

Long bone fractures involving the humerus (upper arm bone) or femur (thighbone) occur far less often. These injuries typically happen only when delivery becomes mechanically challenging.

Skull fractures represent the rarest category and almost exclusively occur during instrument-assisted deliveries using forceps or vacuum extraction.

Which Bones Break Most Often During Delivery

The Clavicle

The collarbone represents the most vulnerable bone during birth. Its location between the shoulder and chest means it experiences direct pressure during passage through the birth canal, particularly when a baby’s shoulders require maneuvering.

Many clavicle fractures heal so quickly and with so few symptoms that they go unnoticed until a small bump appears on the collarbone a week or two later as healing bone forms a callus.

Upper Arm and Thighbone

Humerus and femur fractures occur primarily when significant traction or rotational force becomes necessary to deliver a baby. These injuries can happen during both vaginal births and cesarean sections, though the circumstances differ.

During vaginal delivery, these fractures most commonly occur alongside shoulder dystocia (when the shoulders become lodged) or during breech extraction. During cesarean delivery, they can happen when pulling the baby through a small incision becomes difficult.

Skull Fractures

These injuries present a more complex picture than long bone fractures. They range from thin, hairline cracks that heal without intervention to depressed fractures where a portion of skull bone presses inward.

The severity of a skull fracture matters less for the bone itself, which typically heals well, and more for what it might indicate about forces applied to the head and potential injury to underlying brain tissue.

Less Common Fractures

Tibia (shin bone) and rib fractures occur occasionally but remain rare enough that their presence sometimes prompts additional evaluation to rule out underlying bone mineralization problems or genetic conditions affecting bone strength.

Why These Injuries Happen

Birth fractures result from mechanical forces during delivery. Understanding the specific risk factors helps explain why some babies experience these injuries while most do not.

Shoulder Dystocia

When a baby’s head delivers but the shoulders become stuck behind the mother’s pubic bone, the medical team must act quickly to free the shoulders. The maneuvers required to accomplish this, while potentially lifesaving, can place significant stress on the clavicle and arm bones.

Baby’s Size

Larger babies face higher fracture risk for straightforward mechanical reasons. More mass requires more force to move through the birth canal, and larger shoulders have less room to maneuver.

Macrosomia, the medical term for babies weighing over 8 pounds 13 ounces at birth, consistently appears as a risk factor in fracture studies.

Breech Position

Babies positioned feet-first or bottom-first present unique delivery challenges. Extracting arms and legs in these presentations can place stress on long bones at disadvantageous angles.

Instrument-Assisted Delivery

Forceps and vacuum extractors serve important purposes when delivery needs assistance, but they do apply direct force to the baby’s head. This explains their strong association with skull fractures, though most instrument-assisted deliveries proceed without causing fractures.

First Pregnancies

First-time mothers face higher fracture rates in their babies. This likely relates to the fact that the birth canal has never stretched before, making passage tighter and potentially more difficult.

Prolonged or Difficult Labor

Labor that stalls or progresses slowly can lead to circumstances where more intervention becomes necessary, increasing the likelihood of mechanical complications.

Does Cesarean Section Prevent Fractures

Many people assume that cesarean delivery eliminates fracture risk. While C-sections do avoid birth canal-related forces, they introduce their own mechanical challenges.

Long bone fractures can still occur during cesarean delivery, particularly when the incision is small relative to the baby’s size or when the baby is deeply lodged in the pelvis. Extraction in these circumstances can require pulling or maneuvering that stresses bones.

The overall fracture rate is lower with cesarean delivery, but it is not zero.

How Doctors Identify Broken Bones in Newborns

Most birth-related fractures become apparent within the first hours or days after delivery, though some subtle clavicle fractures escape immediate detection.

Signs That Raise Concern

Newborns with fractures typically show observable changes in behavior or appearance. A baby may consistently avoid moving one limb, cry when that area is touched or moved, or show visible swelling around the injury site.

With clavicle fractures, asymmetry in arm movement often provides the first clue. The baby may keep one arm still against the chest while moving the other normally.

Skull fractures might be suspected if there’s visible swelling on the head, a soft spot in an unexpected location, or neurological symptoms like unusual lethargy or feeding difficulties.

Imaging Studies

X-rays remain the primary tool for confirming most fractures. They quickly reveal breaks in the clavicle, arms, legs, and ribs with clear detail.

For skull fractures, doctors might use ultrasound in addition to or instead of X-rays, particularly in very young newborns where the skull bones haven’t fully hardened. CT scans come into play when doctors need detailed information about skull fracture severity or when there’s concern about brain injury.

When Fractures Are Discovered Later

Some clavicle fractures only become apparent a week or two after birth when a hard lump appears on the collarbone. This lump is callus, the new bone your baby’s body produces to heal the fracture. While discovering an injury after the fact can be upsetting, these late-detected fractures typically cause minimal discomfort and heal completely.

Treatment Approaches for Newborn Fractures

The overwhelming majority of birth-related fractures heal with conservative treatment. Newborn bones possess remarkable healing capacity, typically mending faster and more completely than bones at any other age.

Clavicle Fractures

Most clavicle fractures require nothing more than gentle handling. Some doctors recommend pinning the sleeve to the shirt on the affected side to limit movement, while others simply advise careful positioning during holding and feeding.

Pain management usually involves nothing more than being thoughtful about how you handle and position your baby. The discomfort typically decreases noticeably within a few days.

Healing happens quickly. Within two to three weeks, new bone forms and the fracture becomes stable. By six weeks, the bone has usually healed completely, though the bump of extra bone may take months to fully remodel and smooth out.

Arm and Leg Fractures

Long bone fractures typically require immobilization with a soft splint or, occasionally, a small cast. The goal is to keep the bone aligned and still while healing occurs.

The splinting period is usually short, often just two to four weeks, after which the bone has healed sufficiently to allow normal movement.

Skull Fractures

Linear skull fractures (simple cracks) almost always heal on their own without any intervention. The primary concern is monitoring for any signs of brain injury or complications, which requires neurological observation in the hospital and sometimes follow-up imaging.

Depressed skull fractures, where a piece of bone presses inward, require more careful evaluation. Many still heal spontaneously as the brain grows and expands. Surgery to elevate the depressed segment is reserved for cases where the depression is severe or causing problems.

When Surgery Becomes Necessary

Surgical intervention for birth fractures is extremely rare. Research indicates that only about 1 to 3 percent of cases require procedures like percutaneous pinning, where a small pin is inserted through the skin to hold bone fragments in proper alignment.

These procedures, when needed, are typically minimally invasive and have excellent outcomes.

What to Expect During Recovery

The healing trajectory for birth-related fractures is almost always positive. Permanent complications are exceptionally rare.

Timeline for Healing

Clavicle fractures typically achieve solid healing within three to four weeks, though remodeling of the bone continues for several months. Arm and leg fractures take slightly longer, usually four to six weeks for initial healing.

Skull fractures follow their own timeline, with thin cracks often healing within a month or two and depressed fractures sometimes taking longer or requiring intervention.

Follow-Up Care

Most fractures require at least one follow-up appointment where the doctor examines the healing site and, in some cases, takes repeat X-rays to confirm proper healing.

For skull fractures, particularly those associated with instrument use, more extensive neurological follow-up helps ensure that no underlying injury was missed.

Long-Term Outcomes

Study after study confirms that birth-related fractures heal completely in nearly all cases. Children grow normally, use their limbs normally, and face no limitations related to their newborn injury.

Occasionally, someone with a history of a severe long bone fracture during birth might report mild discomfort or unusual sensations in that area years later, but this represents an extremely rare outcome.

The healed bone typically ends up as strong as it would have been without injury, sometimes even stronger at the site where the fracture healed.

Can These Injuries Be Prevented

Prevention of birth fractures centers on minimizing difficult deliveries and making careful decisions about when and how to use interventions during labor.

Risk Assessment Before Delivery

When doctors identify risk factors like a large baby or breech position before labor begins, they can plan accordingly. This might mean discussing cesarean delivery for certain breech presentations or being prepared for shoulder dystocia in a large baby.

Ultrasound estimates of baby size are not perfectly accurate, but they can help flag situations requiring extra preparedness.

Skilled Management During Delivery

Much of fracture prevention comes down to skilled clinical judgment during labor. Experienced providers know when to allow labor to continue, when to intervene, and how to perform necessary maneuvers with appropriate force.

For instrument-assisted deliveries, proper training and careful application technique can minimize skull fracture risk.

Balancing Competing Risks

The complexity of fracture prevention lies in balancing risks. The maneuvers that might cause a clavicle or arm fracture during shoulder dystocia are often necessary to prevent a much more serious outcome like permanent brain injury from oxygen deprivation.

Doctors must make rapid decisions, weighing the risk of a typically well-healing fracture against other potentially more severe complications.

Questions to Ask Your Medical Team

If your baby has sustained a fracture during birth, clear communication with your medical team helps you understand the situation and feel confident in the care plan.

Important questions include asking about the specific type and location of the fracture, what treatment approach will be used, and what the expected healing timeline looks like. You should understand what symptoms to watch for that might indicate a problem and what follow-up appointments will be needed.

For skull fractures specifically, asking whether any brain imaging has been or will be done provides important information about the completeness of the evaluation.

If you’re confused about how the fracture happened, asking for an explanation of the delivery circumstances can help you understand the events, though sometimes the exact mechanism isn’t completely clear.

Moving Forward After a Birth Fracture

Learning that your newborn has a broken bone can overshadow what should be a joyful time. The injury is real and your feelings about it are valid.

At the same time, the medical evidence provides genuine reassurance. These injuries heal. Your baby will recover completely in almost all cases. The fracture that seems so significant right now will likely be a distant memory by your child’s first birthday.

Focus on what you can control in the present moment: following treatment recommendations, attending follow-up appointments, and giving your baby the gentle care they need during healing.

The healing capacity of newborn bones is remarkable. While birth fractures represent a complication no one wants, the prognosis is genuinely positive for the vast majority of affected babies.