PALSY? ROBERT ALLEN, MICHELE DONITHAN, PATRICIA MOORE, SHAWN STALLINGS, SCOTT PETERSEN, LEORA ALLEN, EDITH GUREWITSCH, Johns Hopkins University, Biomed Eng, Baltimore, MD Johns Hopkins University, Epidemiology, Baltimore, MD Johns Hopkins University, Gyn/Ob, Baltimore, MD Shands Hospital, Ob/Gyn, Gainesville, FL Johns Hopkins University, Nursing, Baltimore, MD OBJECTIVE: To determine, among vaginal deliveries resulting in clavicle fracture (Fx) and/or brachial plexus palsy (BPP), whether Fx is protective against BPP. STUDY DESIGN: With IRB approval, vaginal deliveries associated with Fx and/or BPP were identified from 3 databases: (1) all shoulder dystocia (SD) cases resulting in BPP (1994-1997) from a single institution; (2) all vaginal deliveries complicated by Fx and/or BPP (1993-2003) from a single institution; and (3) litigated cases of permanent BPP with or without SD frommultiple U.S. institutions. BPPs were considered severe if permanent and were complete (C5C8/T1) or involved at least one nerve root avulsion. Mild BPPs were either temporary or permanent without being severe. Cases of isolated Fx and/or mild BPP were compared with severe BPP for associated Fx using chi-square, with significance set at P < 0.05. A stepwise linear regression analysis was performed to control for potential confounding variables and generate odds ratios for predicting BPP. RESULTS: Of 350 vaginal deliveries complicated by Fx and/or BPP, there were 70 isolated Fx, 21 concomitant Fx and BPP, 212 mild BPP, and 68 severe BPP (Table). After controlling for maternal obesity, birth weight, shoulder dystocia and operative vaginal delivery in the regression model, clavicle fracture was negatively associated with BPP (OR 0.1, CI: 0.03-0.57). CONCLUSION: Among vaginal deliveries associated with clavicular fracture and/or brachial plexus palsy, fracture is associated more often with no or mild BPP, whereas infants with severe BPP rarely sustain a concomitant fracture. This may reflect a protective effect of clavicle fracture against brachial plexus palsy.