Risk Variables of Neonatal Clavicular Fracture and the Role of Ultrasound in Its Diagnosis Abstract Background: Newborn bone fractures are a known complication of parturition with neonatal clavicular fracture being the most frequent, at a rate of 3.5% of all deliveries. Early reports implicated a range of fetal factors and maternal variables responsible for clavicular injury. However, more studies that are recent have suggested that no one or a combination of risk factors can be firmly identified. Ultrasound (US) represents a low-cost and radiation-free alternative to the standardized radiography for fractures. It has proved to be particularly accurate in detecting hip dysplasia and even a fracture reduction was possible under ultrasonographic guidance Objective: We studied the characteristics and risk factors involved in neonatal clavicular fracture and the accuracy of ultrasound (us) in clavicular injury diagnosis Study design: This prospective case-controlled study was conducted in AL-Khafji Joint Operation (KJO) Hospital, Kingdom Of Saudi Arabia during the period from August 2013 to September 2016. A total number of 5120 vaginal deliveries were studied for a series of maternal, fetal and pregnancy or delivery-related variables. All infants were delivered vaginally at term by a specialist obstetrician and underwent peripartum sonographic fetal weight estimation. All variables were compared with those of an equal number of infants born immediately before or after each affected infant and delivered by the same obstetrical team. Plain radiograph and ultrasound calvicles were done for all suspected clinically affected neonates Results: The study revealed that fracture clavicles were found in 43 cases out of 5120 vaginal deliveries (0.84%) during the study period. The duration of the second stage of labor, peripartum sonographic fetal weight estimation, shoulder dystocia, increasing gestational age, maternal height and neonatal length were significantly and directly related to occurrence of neonatal clavicular fractures (P<0.05). In contrast, we did not observe any significant association in relation to maternal age, weight and parity (p ˃0.05). US interpretation had 95.35% sensitivity and 97.50% specificity for detecting the neonatal clavicular fracture. Conclusions: The majority of clavicular fractures occur in normal newborns following normal vaginal delivery.The identified risk factors for clavicular fractures offer a method for clinical prediction of suspected cases. Compared to radiographs, US represents a low-cost and radiation-free alternative for diagnosis and follow up cases with fracture