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0 to 2014. Historically Colorado has had a lower BPBI incidence than the United States. Shoulder dystocia, instrumented forceps birth, gestational diabetes, and breech delivery are the biggest predictors for BPBI. Increased awareness of shoulder dystocia and instrumented birth are hypothesized to have reduced these incidences. Nonwhites and Medicaid patients seem to be at higher risk for BPBI. Level of evidence Level II-Prognostic.Background Despite being a common pediatric hand condition, there are few clear guidelines regarding the o