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Infections of the clavicle in children.

Of 23 children with infections of the clavicle, 11 had pyogenic osteomyelitis, four had tuberculosis, and eight (infants) had congenital syphilis. Acute pyogenic infections were treated by drainage. Resection of the clavicle was performed in chronic cases. Curettage and antituberculosis drugs were effective for children with tuberculous infection of the clavicle. Procaine penicillin was used for the treatment of congenital syphilis. Biopsy is generally necessary to differentiate chronic infection from neoplasm.

Biopsy↗

Thoracic outlet syndrome with congenital pseudarthrosis of the clavicle: treatment by brachial plexus decompression, plate fixation and bone grafting.

Although a number of cases of congenital pseudarthrosis of the clavicle have been described in the literature, they provide little direction for the treatment of this condition when it is associated with thoracic outlet syndrome. The authors describe their experience with such a case in a 20-year-old woman. Symptoms of pain in the ulnar distribution of the right forearm and discoloration of the hand with abduction of the extremity had developed over 3 years. The radial pulse was obliterated by abduction of the arm. Exploration of the brachial plexus revealed a constricting band arising from the distal fragment of the clavicle running to the first rib which, together with the mass of the pseudarthrosis, comprised the thoracic outlet. The patient was successfully treated by division of the fibrous band, reduction of the clavicle, internal fixation with a plate and iliac crest bone grafting. At follow-up the patient had a full range of motion in the shoulder and was asymptomatic.

Adult↗

Pneumothorax complicating a fracture of the clavicle.

Fractures of the clavicle, while common, are associated with few serious complications. The authors report the case of a 29-year-old man with a simple fracture of the middle third of the clavicle that was associated with a 30% pneumothorax. The force and mechanism of the injury, severe pleuritic pain and reduced breath sounds suggested the diagnosis which was confirmed roentgenographically. The possibility of pneumothorax must be considered in any patient with a fracture of the clavicle, especially in the unconscious patient who has sustained multiple injuries.

Adult↗

[Characteristics of fractures of the distal part of the clavicle in children].

Fractures of the clavicle are frequent in children and mostly affect the middle third. On the other hand, traumatic fractures of both medial and lateral thirds of the clavicle are rare. The lesions have special characteristics: difficulty in diagnosis for the medial third; risk of callus formation in the absence of surgical reduction of the lateral third. The authors report two observations of fractures of the medial and lateral thirds of the clavicle; they insist on the value of investigation by CT scan.

Child↗

Arthroscopic distal clavicle excision. Technique and early results.

Since 1941, distal clavicle excision has been a reliable technique for alleviating pain caused by acromioclavicular joint arthritis. Disadvantages of the procedure include permanent shoulder weakness, a lengthy recovery time ranging from weeks to months before useful function of the extremity returns, and lack of cosmesis. By modifying the standard portals used to perform arthroscopic subacromial decompression, the authors have successfully excised the distal clavicle of ten consecutive patients. Using this arthroscopic technique, the surgical time averaged approximately one hour 40 minutes, blood loss was negligible, and there were no complications. Operations were performed in an outpatient setting. Five of ten patients missed work only on the day of surgery, and seven of ten patients required no formal physical therapy. All ten patients achieved a good or excellent result on the UCLA. Shoulder Scale for short-term follow-up evaluation. Postoperative radiographs documented adequate bone resection in all cases. In experienced hands, arthroscopic distal clavicle excision is an excellent substitute for the "open" procedure.

Acromioclavicular Joint↗

Hematogenous osteomyelitis of the clavicle in children.

Recognition of acute hematogenous osteomyelitis of the clavicle can be difficult. The condition may even to confused with fracture or malignancy. Treatment with parenteral antibiotics must be continuous for at least three weeks. If there is evidence of abscess formation, incision and drainage is indicated. If surgery is performed, a thorough debridement or partial resection may be required to prevent recurrence. If inadequately treated, the process becomes chronic. Resection of involved portion of the clavicle has been effective in the chornic stage of the disease. In the young child the resected segment often regenerates and the clavicle completely reconstitutes itself.

Acute Disease↗

Treatment of posterior epiphyseal disruption of the medial clavicle with a modified Balser plate.

BACKGROUND: Acute posterior dislocation of the sternoclavicular joint is a rare but dangerous injury that is often difficult to diagnose. Because of late closure of the medial clavicular epiphysis, epiphyseal disruption must be taken into consideration in patients up to 25 years of age with an apparent diagnosis of posterior sternoclavicular dislocation. We developed a novel method of treating epiphyseal disruptions with a modified Balser plate. METHODS: This method was used in a 19-year-old patient with a posterior epiphyseal disruption of the left medial clavicle. After molding of the plate, the hook was introduced into the manubrium sterni and the plate was fixed on the clavicle with screws. RESULTS: The new method could be applied safely and achieved a good functional result without any external immobilization. The postoperative course was uneventful. CONCLUSION: Fixation of the posterior epiphyseal disruption of the medial clavicle with a modified Balser plate is feasible and may be an alternative to traditional methods.

Adult↗

[Mistakes in the diagnosis and treatment of the complete dislocation and fractures of the acromial end of the clavicle].

The analysis of the mistakes in the operative treatment of the sick with such a trauma was conducted. Two typical examples were given. The mistakes were stipulated non-diagnosis of the simultaneous break of the coracoclavicular ligament and not taking measures for its recovery. The radiodiagnosis based on N. Z. Shmidt's method is considered to be inevitable for this category of the sick. After the confirmation of the diagnosis the operation of choice can be the operation of Yotkins-Leochuk for the sick with the complete dislocation of the acromial end of the clavicle, and the operation of Yotkins for the sick with fractures of the acromial end of the clavicle with the break of the coracoclavicular ligament. By means of these methods 43 sick men with the dislocation and 7 sick men with fractures of the acromial end of the clavicle have been operated since 1973. No cases had complications, relapses or unsatisfactory results.

Acromioclavicular Joint↗

Osteomyelitis of the clavicle.

Osteomyelitis of the clavicle is a rare entity and can occur as a complication of head and neck surgery. Ten consecutive cases of the clavicular osteomyelitis were reviewed at the University of California Medical Center, Los Angeles, over the past seven years. Six cases were associated with prior surgical procedures, and five cases presented as chronic wound drainage. One case was related to a pharyngocutaneous fistula following a supraglottic laryngectomy. Four patients presented with acute symptoms resulting from hematogenous spread, and two of the four patients had Staphylococcus aureus on blood cultures. Long-term intravenous antibiotic therapy (six to eight weeks) was used to successfully treat cases of hematogenously spread osteomyelitis. Wide surgical débridement was the mainstay of treatment in the chronic conditions, with antibiotic therapy having a secondary role. Myocutaneous flaps were required in two patients who had had surgery and antecedent radiotherapy. To conclude, the surgeon should be aware that osteomyelitis of the clavicle can occur as a complication of head and neck procedures. In addition, the treatment of the chronic form of clavicular osteomyelitis is surgical débridement and possible flap reconstruction.

Adult↗

"Hominoid clavicle" from Sahabi is actually a fragment of cetacean rib.

A late Miocene/early Pliocene mammalian fossil from the site of Sahabi, Libya, was identified in previous publications as a clavicle belonging to the superfamily Hominoidea. After studying both a cast of the specimen and previously published descriptions and photographs we have concluded that the fossil is not a clavicle, but a rib fragment. In addition, our study demonstrates beyond reasonable doubt that this rib belongs not to a primate, but to a marine mammal. Following comparisons with 19 species in 14 genera of marine mammals, as well as six hominoid and three cercopithecoid species, both modern and fossil, we conclude that the specimen is best attributed to the Odontoceti, the cetacean suborder containing dolphins and porpoises. The rib indicates an animal in the size range of Recent Tursiops or Lagenorhynchus.

Animals↗

Radiographic changes in the clavicle and proximal femur and their use in the determination of skeletal age at death.

Visually seriated radiographs of the proximal femur, proximal humerus, clavicle, and calcaneus from 130 individuals from the Hamann-Todd collection were examined as indicators of skeletal age at death. The clavicle demonstrated the most consistent relationship to age in both sexes. The same radiographs were also seriated by size-normalized optical density as a means of establishing relative radiolucency. In this context, visual seriation proved superior. The four sites studied showed strong divergence in response to age. Since each was sampling bone response from the same individual, it is concluded that bone loss is highly site specific. This demonstrates the individual character of specific skeletal sites. Visual inspection of clavicular radiographs, seriated on a populational basis, provides age estimates that are comparable to anatomical age indicators and provides independent estimates of skeletal age when included in the summary age method (1985: Am. J. Phys. Anthropol. 68:1-14).

Adolescent↗

Age estimation from cortical index of the human clavicle in northwest Indians.

The proportion of the cortical thickness to the total diameter of the bone (cortical index) was calculated in paired clavicles obtained from 128 male and 82 female medicolegal postmortem subjects who were apparently healthy prior to their accidental death. The ages of the subjects varied from 15 to 85 years. The clavicles were cut either horizontally or parasagittally, and measurements were taken at midclavicle. From the ages of 15 to 30 years, the cortical index increased. It decreased steadily thereafter, with an initial sharp decrease in the age group 31-40 years in both sexes. After the age of 40 years, this rapid decrease in the index continued in the females, but became slow and gradual in the males. Differences between left and right sides were statistically insignificant in both sexes (P greater than 0.05). However, the sexual differences were significant (P less than 0.01) in the age groups from 41 years onwards.

Adolescent↗

Clavicles, scapulae and humeri from the Sima de los Huesos site (Sierra de Atapuerca, Spain).

The scapulae, clavicles and humeri recovered from the Sima de los Huesos (SH) site between 1976 and 1994 are studied. All elements are briefly described anatomically with metrics and compared with other fossil hominids in order to establish the morphological pattern of the SH hominids. A minimum of 13 individuals are represented by the humeri in the SH sample. Almost all of them can be classified as adolescents and young adults. The morphology of the SH hominid shoulder girdle and humeri indicates that much of the shoulder morphology recognized in the later true Neandertal was present in Europe long before they appeared. Thus, this morphological pattern is not exclusive to Neandertals alone. The SH clavicles, scapulae and humeri share with the Neandertals many traits usually considered to be Neandertal specializations. The comparative analysis of the SH evidence suggests that most of the SH and Neandertal shared traits are either primitive features within the genus Homo or even for all hominids, or display high variability within different hominid samples. These traits must be used with caution, or not used at all, in phylogenetic analysis. There are, however, traits that to date have only been detected in the SH hominids and the Neanderials, which could be exclusive to the European phyletic lineage (clade) of Homo.

Adolescent↗

Inflammatory hyperostosis and sclerosis of the clavicle.

Six cases with chronic inflammatory hyperostotic and sclerotic changes of the clavicle are reported. No causative organisms could be detected. Four patients had involvement of other bones including the thoracic spine, the femur, the tibia and the sternal end of the other clavicle. These may be classified as having "chronic recurrent multifocal osteomyelitis" (CRMO). The remaining two patients with similar clavicular changes might have an, as yet, unifocal CRMO.

Adolescent↗

[Contribution to the osteolysis in distal end of the clavicle (author's transl)].

A case of rare osteolysis of the distal clavicle end is reported. Our 36-years old male patients also suffered from a well-discernible Hyperlipoproteinemia, type II/a after Fredrickson. A short view of the various forms of clavicle osteolysis is given. Their differentialdiagnostical and ethiological relations are discussed.

Adult↗

Post-traumatic osteolysis of the distal clavicle.

We report a case of post-traumatic osteolysis of the distal clavicle of a 25-year-old man. The diagnosis was missed for several months, and the patient continued to have pain in his right shoulder. The pain continued in spite of intensive physiotherapy. When he was seen for the first time in our clinic 6 months after the accident, the radiographs showed an osteolysis of the distal clavicle.

Acromioclavicular Joint↗

The lateral clavicle hook-an acquired as well as a congenital anomaly.

The lateral clavicle hook (LCH), an excessive upward convexity of the lateral clavicle, was formally defined by Igual and Giedion, and reported as always present in thrombocytopenia-radial aplasia syndrome and sometimes in other congenital malformations. Additional malformation syndromes including camptomelia are added. In addition, the hook may be seen in acquired upper extremity weakness such as in persistent brachial plexus injury after birth trauma and in severe osteogenesis imperfecta.

Adolescent↗

Calcitonin and parathyroid hormone in newborn infants with fracture of the clavicle.

Determinations of serum calcium (Ca), phosphorus (P), calcitonin (CT), and parathyroid hormone (PTH) were carried out in 36 full-term newborn infants with fracture of the clavicle (CF) and in 46 normal neonates (N). At the 6th hour of life the CF neonates demonstrated lower serum Ca and higher serum CT in comparison with normal infants. In the hours following, no significant differences between the two groups for the Ca levels were found, whereas serum CT remained significantly higher in the CF newborns at the 24th, 48th, and 72nd hour of life. Significant differences between normal and CF infants in the PTH serum levels were detected only at the 48th hour, when PTH was lower in the CF newborns. The results of this investigation indicate that the fracture of the clavicle is a significant and peculiar factor in stimulating CT secretion. Serum Ca level appeared to be controlled by CT rather than auto-regulating the secretion of the hormone.

Birth Injuries↗