Congenital Pseudarthrosis of the Clavicle: A Case Report

Abstract

Congenital pseudarthrosis of the clavicle is a rare entity of unknown aetiology. Its pathogenesis is related to the embryology of the clavicle. We present a 6-year-old girl with congenital pseudarthrosis of the right clavicle. A prominence was noticed at birth between the middle and distal ends of the clavicle that increased in size when the right shoulder was actively mobilised. Radiographic examination revealed a hypertrophic pseudarthrosis of the clavicle. The pseudarthrosis was resected and the clavicular segments were fixed with an external fixator for 2 months until union. Clinical results were excellent at the 7-year follow-up: the right shoulder was pain-free and the appearance satisfactory. Surgical treatment of congenital pseudarthrosis of the clavicle in children using an external fixator provides a better cosmetic outcome with smaller postoperative scars and avoids a second surgical procedure to remove the implants.

Failed operative treatment in two cases of pseudarthrosis of the clavicle using internal fixation and bovine cancellous xenograft (Tutobone)

“…The pin was removed at 1 year and the lesion healed uneventfully. Beslikas et al [11] treated a single case with resection and the pseudarthrosis and fixation with an external fixator for 2 months until union. Clinical results were deemed excellent at the 7-year follow-up: the shoulder was pain free and the appearance satisfactory.…”

“…The most commonly described surgical technique involves resection of the pseudarthrosis, iliac crest bone grafting and plate fixation [7]. Other fixation methods have been reported including K-wires [8], Steinmann pins [9], intramedullary fixation [10] and external fixation [11]. There are no published reports of bone graft substitute being used in place of iliac crest graft; however, a series of 17 cases treated surgically showed that when no bone graft was used the nonunion rate was higher (3/8 vs. 0/9) [12].…”

Late presentation of congenital pseudarthrosis of the clavicle

“…Grogan et al [10] reported excellent results in eight children (from 7 months to 6 years) in whom the fibrous pseudarthrosis was resected early, carefully preserving the continuity of the periosteal sleeve and approximating the bone ends without grafting. External fixation after pseudoarthrosis excision without bone grafting has been described with good result, smaller scar and avoidance of the second operation for hardware removal [4] . After the age of 8 years, it appears to be more difficult to obtain fusion, and an alternative to bone grafting is excision of the prominent lateral end of the sternal half of the clavicle.…”

The Shoulder: Congenital and Developmental Conditions

“…Most patients present during the fi rst 2 years of life. More than 200 cases have been reported in the literature [ 3 ]. Most are isolated abnormalities, but some result from autosomal recessive inheritance; bilateral lesions are extremely rare and may result from autosomal dominant inheritance.…”