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PubMed2006

[Congenital pseudarthrosis of the clavicle: a review of nine cases].

BACKGROUND: Congenital pseudarthrosis of the clavicle (CPC) is a rare malformation of the scapular waist of unknown etiology. About 200 cases have been reported. The lesion is usually right-sided and unilateral. Physical examination reveals swelling over the midportion of the clavicle, usually asymptomatic, and the diagnosis is confirmed by plain radiology. The differential diagnosis includes posttraumatic pseudarthrosis, cleidocranial dysostosis and neurofibromatosis. Surgical treatment is indicated in symptomatic patients or those with major deformity. MATERIAL AND METHODS: We performed a retrospective review of the medical records of 9 patients with CPC managed in our hospital. RESULTS: We studied 5 girls and 4 boys with unilateral right CPC. None of them had a familial history of CPC. Four complained of local pain, without functional impairment, and clavicular asymmetry on x-ray ranging from 0.5 to 1 cm, without accompanying pathologic findings. Surgical treatment was performed in 5 patients, with resection of fibrous pseudarthrosis, internal fixation, and iliac bone graft. In 4 patients callus response was achieved at 2 months. The remaining patient required withdrawal of orthopaedic material 2 months after surgery because of its protrusion through the skin, without the need for further surgical treatment to date. CONCLUSIONS: Although rare, CPC should be included in the differential diagnosis of clavicle abnormalities in children. Good results are achieved with current surgical techniques in patients with clear indication.

Child, Preschool↗
PubMed2000

Surgical treatment of comminuted fractures of the distal clavicle using Wolter clavicular plates.

Surgical reduction and fixation using Wolter clavicular plates was performed in 16 patients with distal clavicle fractures. Good bony union was obtained in all cases. The patients had neither postoperative pain nor muscle weakness. Compared with tension band wiring, the Wolter clavicular plates were better able to maintain the anatomic repositioning of comminuted distal clavicle fractures. However this method takes longer and requires a second operation for plate removal. Wolter clavicular plate placement is the treatment of choice for unstable distal clavicle fractures with small comminuted fragments.

Adult↗
PubMed1985

Excision of the clavicle. A review of the nineteenth-century literature.

Reports of excision of the clavicle in the nineteenth century literature are reviewed, and certain operative complications discussed. Osteomyelitis was the most common indication, and was described first in this country by Syme in 1833. The first successful excision of the entire clavicle was performed by McCreary of Kentucky in 1813. The removal of tumour-bearing clavicles provided memorable challenges at a time when anaesthetics were not available, blood transfusion unknown and antibiotic therapy non-existent.

Clavicle↗
PubMed1997

Closed treatment of displaced middle-third fractures of the clavicle gives poor results.

We evaluated 242 consecutive fractures of the clavicle in adults which had been treated conservatively. Of these, 66 (27%) were originally in the middle third of the clavicle and had been completely displaced. We reviewed 52 of these patients at a mean of 38 months after injury. Eight of the 52 fractures (15%) had developed nonunion, and 16 patients (31%) reported unsatisfactory results. Thirteen patients had mild to moderate residual pain and 15 had some evidence of brachial plexus irritation. Of the 28 who had cosmetic complaints, only 11 considered accepting corrective surgery. No patient had significant impairment of range of movement or shoulder strength as a result of the injury. We found that initial shortening at the fracture of > or = 20 mm had a highly significant association with nonunion (p < 0.0001) and the chance of an unsatisfactory result. Final shortening of 20 mm or more was associated with an unsatisfactory result, but not with nonunion. No other patient variable, treatment factor, or fracture characteristic had a significant effect on outcome. We now recommend open reduction and internal fixation of severely displaced fractures of the middle third of the clavicle in adult patients.

Adolescent↗
PubMed2003

Ultrasonographic imaging of fractures of the clavicle in newborn infants.

Fractures of the clavicle in the neonate are usually diagnosed by clinical examination and confirmed by plain radiography. Exposure of newborn infants to irradiation should be avoided if possible. Following the clinical examination of 2978 neonates, 15 had suspected fractures of the clavicle. All were confirmed by ultrasound. In combination with clinical examination, ultrasound is a satisfactory alternative to radiological assessment for the diagnosis of fractures of the clavicle in newborn children.

Clavicle↗
PubMed2002

Management of paediatric clavicle fractures--is follow-up necessary? An audit of 346 cases.

We investigated the incidence of complications following childhood clavicle fractures and the necessity for follow-up in fracture clinic after the first orthopaedic consultation. We found that review in fracture clinic has no impact upon the outcome of clavicle fractures and complications such as non-union, mal-union or neurovascular problems are exceptionally rare. We concluded that there is no need for follow-up of children with isolated, uncomplicated clavicle fractures. These patients should be discharged after their first assessment in fracture clinic.

Adolescent↗
PubMed2007

Development of the mouse mandibles and clavicles in the absence of skeletal myogenesis.

In this report we employed double-knock-out mouse embryos and fetuses (designated as Myf5-/-: MyoD-/- that completely lacked striated musculature to study bone development in the absence of mechanical stimuli from the musculature and to distinguish between the effects that static loading and weight-bearing exhibit on embryonic development of skeletal system. We concentrated on development of the mandibles (= dentary) and clavicles because their formation is characterized by intramembranous and endochondral ossification via formation of secondary cartilage that is dependent on mechanical stimuli from the adjacent musculature. We employed morphometry and morphology at different embryonic stages and compared bone development in double-mutant and control embryos and fetuses. Our findings can be summarized as follows: a) the examined mutant bones had significantly altered shape and size that we described morphometrically, b) the effects of muscle absence varied depending on the bone (clavicles being more dependent than mandibles) and even within the same bone (e.g., the mandible), and c) we further supported the notion that, from the evolutionary point of view, mammalian clavicles arise under different influences from those that initiate the furcula (wishbone) in birds. Together, our data show that the development of secondary cartilage, and in turn the development of the final shape and size of the bones, is strongly influenced by mechanical cues from the skeletal musculature.

Animals↗
PubMed1992

Atraumatic osteolysis of the distal clavicle. A review.

Atraumatic osteolysis of the distal clavicle (AODC) in athletes is a stress failure syndrome of the distal clavicle. It is related to intolerable exercise doses. For some athletes, the acromioclavicular joint is the weak link in the musculoskeletal system. There is never a history of a major injury to the acromioclavicular joint. It occurs principally in young athletes who have a long history of training and performance. It is further characterised by athletes who generally have an associated intense strength training programme. The condition will inexorably progress to decrease the level of performance and later interfere with activities of daily living. If the athlete is unwilling to alter his or her exercise training and performance regimen, she or he will eventually become surgical candidates. The results of excision of the distal clavicle for AODC are good or excellent in virtually all cases. The diagnosis of AODC is confirmed by the history of accumulative exercise doses and the key historical feature of intensive participation in strength training. Local tenderness will be found at the acromioclavicular joint, plain radiographs will show degenerative changes in the vast majority of cases and joint scintigraphy must be positive to confirm the diagnosis.

Acromioclavicular Joint↗
PubMed1991

Condensing osteitis of the clavicle: a rare but frequently misdiagnosed condition.

Condensing osteitis of the clavicle is a benign, often painful disorder, marked by bony sclerosis at the sternal end of the clavicle. It can be mistaken for other abnormalities such as Friedrich disease, bone island, osteoid osteoma, sternoclavicular osteoarthritis, and even a metastasis and osteosarcoma. Clinical, radiologic, scintigraphic, and histologic features of this condition are discussed and a brief overview of the treatment is provided. Three histologically proved cases are added to the 13 previously reported in the literature. Recognition of condensing osteitis of the clavicle may avoid the occasional unnecessarily aggressive diagnostic approach taken to search for a malignant tumor.

Adult↗
PubMed2006

Nontraumatic disorders of the clavicle.

Other than those resulting from trauma and arthritis, disorders of the clavicle are uncommon. Some nontraumatic disorders are found only in infancy and childhood, such as birth fracture, infantile cortical hyperostosis, congenital pseudarthrosis, cleidocranial dysplasia, and short clavicle syndrome. Other nontraumatic disorders occur in both children and adults; these include anterior subluxation of the sternoclavicular joint, Friedrich's disease, hypertrophic osteitis, chronic multifocal periosteitis and arthropathy, and osteomyelitis. Some nontraumatic clavicular disorders are found only in adults, such as distal osteolysis. Because the description and nomenclature of these disorders arise from several medical disciplines, they often are confusing. Until clear, distinguishing features are described, it is advisable to combine some of the entities. This is especially true of the nonsuppurative inflammatory disorders of the clavicle, which appear to fall under the heading of spondyloarthropathy. Treatment varies by disorder and may include symptomatic and expectant management, drug therapy, and nonsurgical or surgical treatment.

Adolescent↗
PubMed1999

Bilateral congenital pseudarthrosis of the clavicle report of a case with clinical, radiological and neurophysiological evaluation.

Congenital pseudarthrosis of the clavicle is a rare condition. Bilateral involvement is extremely rare: only seven cases have been reported in the literature. Although the anatomy of the thoracic outlet can be markedly altered by the hypermobility of the shoulder and although few cases with mild symptoms suggesting brachial plexus impairment have been reported, the neurological status of the brachial plexus in congenital pseudarthrosis of the clavicle has not been well assessed. We report a case of bilateral congenital pseudarthrosis of the clavicle in which clinical, neurophysiological and radiological evaluations were performed.

Child, Preschool↗
PubMed2000

[Retrosternal dislocation of the clavicle complicated by subclavian venous thrombosis. Case report and review of the literature].

Retrosternal dislocation of the clavicle is a highly uncommon lesion. Diagnosis may be delayed with the risk of discovery after severe complications resulting from the protrusion of the medial part of the clavicle into the anterosuperior mediastinum. Currently, diagnosis is based on computed tomographic findings. We report a case of retrosternal dislocation of the clavicle complicated by subclavian venous thrombosis and review the therapeutic indications proposed in the literature.

Adult↗
PubMedDate not supplied

Primary osteogenic sarcoma of the clavicle. Case report.

The clavicle is an unusual site for any primary bone tumor, including osteogenic sarcoma. The authors report the case of a young girl aged 13 years who was affected with primary osteogenic sarcoma of the right clavicle, and who was treated by preoperative and postoperative chemotherapy and radical clavicle excision, including the acromioclavicular and the sternoclavicular joints.

Acromioclavicular Joint↗
PubMed2003

Osteoblastoma of the clavicle.

A 14-year-old female with a 1-year history of a painful clavicle mass underwent resection and reconstruction with an intercalated autograft and rigid plate fixation. The histopathology was diagnostic for osteoblastoma. Although a clavicle mass is a common entity following clavicle trauma, less common disorders such as bone tumors need to be considered in the differential diagnosis. Osteoblastoma is an uncommon, benign bone tumor representing 1% of all primary bone tumors. An extensive review of the literature reveals only one reported case of clavicular osteoblastoma.

Adolescent↗
PubMed2004

[Radiography of the medial ends of the clavicles by the method of the Dutch Immigration and Naturalisation Service is unsuitable for determining adulthood].

OBJECTIVE: A critical examination of the radiological technique used by the Dutch Immigration and Naturalisation Service (IND) for determining the adulthood of persons around the age of 18. DESIGN: Descriptive. METHOD: Radiographs of the hands and clavicles were reassessed in 29 asylum seekers (15 boys, 9 girls and 5 persons of unknown gender) in whom the IND suspected a discrepancy between the true age and the age stated. In each case, 1 hand radiograph and 3 clavicular views were taken: 1 posteroanterior standard view as well as 2 oblique views, in order to assess the epiphyses at the medial ends of the clavicles. Additionally, the radiographs of one of these subjects were shown to 241 radiologists and radiologists-in-training. RESULTS: On all the hand X-rays, the epiphyses were closed. Based on this, the skeletal age of the girls was at least 15 years and 11 months and that of the boys at least 17 years and 3 months. The medial ends of the clavicles could not be assessed on the standard views due to overprojection of the spinal column. In 55 of the 58 films in which the thorax was turned, the direction of the X-rays was not appropriate for assessing the growth plates. The other 3 could not be assessed as there were no existing objective radiological criteria. The assessments of the stage of development as an indication of skeletal age in the cases presented differed greatly from one another. CONCLUSION: The radiographs that were taken to establish whether or not the asylum seekers were underage were unsuitable for the purpose for which they were taken.

Adolescent↗
PubMed2004

Bilateral clavicle non-unions treated with anteroinferior locking compression plating (LCP): a case report.

The author reports the case of a 30-year-old female patient with bilateral atrophic non-union of the clavicle; the latter both healed after internal fixation with a locking compression plate fixed on the anteroinferior aspect of the clavicle, combined with autologous cancellous bone grafting. The advantages of the anteroinferior positioning of the plate on the clavicle are presented.

Adult↗
PubMed2005

[A case of congenital pseudarthrosis of the clavicle].

Congenital pseudarthrosis of the clavicle is a rare condition of unknown etiology. It usually presents as a painless mass in the clavicular region; however, it may sometimes be associated with pain and weakness in the shoulder. We presented a 21-year-old male patient who had pain and weakness in the right shoulder during sportive and daily vigorous activities due to congenital pseudarthrosis of the clavicle. The patient was successfully treated by excision of the ends of the medial and lateral fragments, reconstruction of the defect with a tricortical iliac crest autograft, and internal fixation of the clavicle with a plate and bone screws. After seven months postoperatively, his complaints disappeared, with a full range of motion and Constant score.

Adult↗
PubMed2006

Non-union of the clavicle and delayed union of the proximal fifth metatarsal treated with low-intensity pulsed ultrasound in two soccer players.

Operative treatment has become the treatment of choice in athletes and active patients in non-union of the clavicle and delayed union of the proximal fifth metatarsal. The purpose of this study was to review the short- and long-term clinical results of low-intensity pulsed ultrasound treatment in a non-union of the clavicle and in a delayed union of the proximal fifth metatarsal in 2 elite soccer players. In both patients, the treatment sessions were performed with an ultrasound signal that was composed of a burst width of 200+/-10% mus containing 1.5+/-5% MHz sine waves, with a repeating rate of 1+/-10% kHz and a spatial average temporal intensity of 30+/-30% mW/cm2. The application of the ultrasound was performed by the patients at home for 20 min/day for 3 months. The healing of the non-union of the clavicle was followed by MR imaging and of the delayed union of the proximal fifth metatarsal by radiographs. In both of the cases the end-results were excellent and the players could continue playing at the highest level. The ultrasound method was successful and afforded players a quick return to sport activity.

Adult↗