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Re: Claviular fractureFrom: Braun, R. Daniel (rbraun@iupui.edu)Wed Jan 21 05:52:44 2004
As usual, Very well put. Dan -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of John Patrick Ogrady Md Sent: Wednesday, January 21, 2004 3:40 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Claviular fracture Gentlemen/ladies: I feel the need to add my 2 bits to this discussion as I have spent a little time in clinical practice and do teach obstetrics. In my experience intentional clavicular fracture is quite difficult. This attempt is usually a waste of time and should not be attempted or considered in the mgt of shoulder dystocia. In our service we neither teach or recommend this technique. The clavicle may spontaneously fracture either during a normal, uncomplicated delivery or during a shoulder dystocia. In neither case would I consider the event to be indicitive of little save perhaps a bit of a tight fit. Thus, I consider a fx of the clavicle a relatively normal and almost always a clinically inconsequential event. The importance of a clavicular fx to dystocia resolution is at best moot. I know of no authority who recommends this technique. The importance of clavicular fracture is not that it does occur but what is made of the occurrence -- that is, this fact of a fracture is used by the uninformed or by those who desire to misinform as a measure or marker of excessive force especially when a brachial plexus injury is claimed to have occurred in association with improper management of a shoulder dystocia. In sum, intentional clavicular fx has virtually no place in the appropriate and modern management of shoulder dystocia. True, this bone may fx during the extraction procedures but it is quite unlikely that the fx has much to do with the dystocia resolution and more to do with the "infernal jiggles" that occur when a difficult dystocia is encountered. Clinicians should not waste time attempting to fx this bone whilst failing to perform the well established and known to be effective maneuvers to resolve a dystocia. This whole issue will doubtless continue as long as we have suits for dystocia injury; paid consultants with access to pen/paper/ or email and volumes of hard liquor. j p ogrady md baystate medical ctr
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