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PubMedDate not supplied

Atraumatic osteolysis of the distal clavicle. Results of open surgical excision.

A group of 14 patients underwent 17 consecutive open surgical excisions of the distal clavicle for atraumatic osteolysis after having failed conservative treatment. All patients were men involved in weight training or heavy-lifting occupations. The diagnosis was based on no history of shoulder trauma, positive plain radiographs, and positive joint scintigraphy. All 14 patients were available for followup at an average of 25 months postoperatively. The UCLA Shoulder Rating Scale was used for evaluation. All patients reported full return to sports and employment at a satisfactory level. All results were rated as excellent (8) or good (9). Eleven of the 14 patients had bilateral involvement to some extent. One patient had undergone open excision of the contralateral distal clavicle before the study and 3 patients presented with bilateral symptoms and underwent staged bilateral excisions during the study. Seven patients presented with contralateral symptoms and radiographic involvement at latest followup after return to weight-lifting activities.

Adolescent↗
PubMed2005

Diagnostic dilemma of an atraumatic clavicle fracture following radical treatment for laryngeal carcinoma.

An atraumatic clavicular fracture presented after radical treatment for laryngeal carcinoma. This presented a diagnostic dilemma. The differential diagnosis included metastatic bone disease and osteomyelitis as well as post-radiotherapy complications. After investigation, the cause was thought to be a post-radiation fracture of the clavicle and to the best knowledge of the authors, this is the first ever documented in a patient who had undergone a total laryngectomy with bilateral modified radical neck dissections and post-operative radiotherapy. Cases of a fractured clavicle post-radiation have been most commonly documented in patients with breast cancer and only a few cases have been documented in patients with laryngeal cancer treated with a total laryngectomy, bilateral radical neck dissections and radiotherapy.

Biopsy↗
PubMed1982

Fracture of the clavicle following radical neck dissection and postoperative radiotherapy: a case report and review of the literature.

The treatment of head and neck cancer with radiotherapy and radical neck dissection has many recognized complications. Radiotherapy in therapeutic doses can produce devascularization and weakening of bone. Radical neck dissection results in altered mechanics of the shoulder girdle and a disruption of normally balanced forces acting on the clavicle. An unusual case of clavicle fracture which is considered to have resulted from an interaction of the effects of these therapies is discussed. An approach for recognizing and distinguishing this entity by its time course, and radiographic and nuclide bone scan appearance is presented.

Adult↗
PubMed1990

Condensing osteitis of the clavicle: does it exist?

Condensing osteitis of the clavicle was first described as a disease entity in 1974. There is painful localised swelling of the clavicle of undetermined origin, with increased radio-density, but an infective aetiology has not been excluded by previous authors. We report three children with the clinical and radiological findings of 'condensing osteitis'. Two of them had raised levels of antistaphylolysin titres and all responded to antibiotic therapy. We conclude that condensing osteitis is due to low-grade staphylococcal osteomyelitis; biopsy and treatment by antibiotics is recommended.

Anti-Bacterial Agents↗
PubMed1991

Coracoclavicular screw fixation for unstable fractures of the distal clavicle. A report of five cases.

Five consecutive unstable fractures of the distal third of the clavicle were treated by indirect open reduction and internal fixation using a temporary Bosworth-type screw. Coracoclavicular fixation provided and maintained reduction of the fracture. Healing occurred uneventfully within nine weeks in all cases. The screw was removed under local anaesthesia after healing of the fracture and there were no surgical complications. Shoulder function was restored to the pre-injury level. Temporary coracoclavicular screw fixation appears to be a valuable alternative for the treatment of type II fractures of the distal third of the clavicle.

Adult↗
PubMed2003

Bilateral aseptic necrosis of the outer end of the clavicle.

We describe a 46-year-old woman who presented at intervals of seven years with osteonecrosis of the outer end of both clavicles. The clinical, radiological features and the appearances of the bone scans are described. Although the condition may be confused with osteolysis there is a dear histological distinction between the two conditions. If the symptoms fail to respond to conservative treatment, excision of the outer end of the clavicle is recommended.

Clavicle↗
PubMed2003

Midshaft malunions of the clavicle.

BACKGROUND: The purpose of this study was to analyze the functional results of corrective osteotomy of a malunited clavicular fracture in patients with chronic pain, weakness, neurologic symptoms, and dissatisfaction with the appearance of the shoulder. METHODS: We identified fifteen patients (nine men and six women with a mean age of thirty-seven years) who had a malunion following nonoperative treatment of a displaced midshaft fracture of the clavicle. The mean time from the injury to presentation was three years (range, one to fifteen years). Outcome scores revealed major residual deficits. The mean amount of clavicular shortening was 2.9 cm (range, 1.6 to 4.0 cm). All patients underwent corrective osteotomy of the malunion through the original fracture line and internal fixation. RESULTS: At the time of follow-up, at a mean of twenty months (range, twelve to forty-two months) postoperatively, the osteotomy site had united in fourteen of the fifteen patients. All fourteen patients expressed satisfaction with the result. The mean DASH (Disabilities of the Arm, Shoulder and Hand) score for all fifteen patients improved from 32 points preoperatively to 12 points at the time of follow-up (p = 0.001). The mean shortening of the clavicle improved from 2.9 to 0.4 cm (p = 0.01). There was one nonunion, and two patients had elective removal of the plate. CONCLUSIONS: Malunion following clavicular fracture may be associated with orthopaedic, neurologic, and cosmetic complications. In selected cases, corrective osteotomy results in a high degree of patient satisfaction and improves patient-based upper-extremity scores.

Adult↗
PubMed2004

Midshaft malunions of the clavicle. Surgical technique.

BACKGROUND: The purpose of this study was to analyze the functional results of corrective osteotomy of a malunited clavicular fracture in patients with chronic pain, weakness, neurologic symptoms, and dissatisfaction with the appearance of the shoulder. METHODS: We identified fifteen patients (nine men and six women with a mean age of thirty-seven years) who had a malunion following nonoperative treatment of a displaced midshaft fracture of the clavicle. The mean time from the injury to presentation was three years (range, one to fifteen years). Outcome scores revealed major residual deficits. The mean amount of clavicular shortening was 2.9 cm (range, 1.6 to 4.0 cm). All patients underwent corrective osteotomy of the malunion through the original fracture line and internal fixation. RESULTS: At the time of follow-up, at a mean of twenty months (range, twelve to forty-two months) post-operatively, the osteotomy site had united in fourteen of the fifteen patients. All fourteen patients expressed satisfaction with the result. The mean DASH (Disabilities of the Arm, Shoulder and Hand) score for all fifteen patients improved from 32 points preoperatively to 12 points at the time of follow-up (p = 0.001). The mean shortening of the clavicle improved from 2.9 to 0.4 cm (p = 0.01). There was one nonunion, and two patients had elective removal of the plate. CONCLUSIONS: Malunion following clavicular fracture may be associated with orthopaedic, neurologic, and cosmetic complications. In selected cases, corrective osteotomy results in a high degree of patient satisfaction and improves patient-based upper-extremity scores.

Adult↗
PubMed1976

Posttraumatic osteolysis of the distal clavicle with emphasis on early radiologic changes.

Erosion of progressive resorption of the distal clavicle following trauma has been described but merits greater attention due to its frequency. Six cases of posttraumatic osteolysis of the distal clavicle are reported with emphasis on early radiographic detection. Soft tissue swelling, deminerlization, and loss of the subarticular cortex at the injured clavicular tip antecede the more commonly recognized gross erosion. Recognition of this early stage, with consequent immobilization, may shorten the course of this process and decrease the prolonged disability. The pathogenesis of the process is discussed and illustrated.

Adult↗
PubMed1983

Resection of the lateral end of the clavicle. A 3 to 30-year follow-up.

Fifty patients, operated on with resection of the clavicle, were evaluated postoperatively after an average of 9 years. There was no significant difference between the traumatic and non-traumatic group. The initial results did not alter significantly with time. Nearly half of the patients with poor outcome had psychiatric or alcoholic problems. Radiographic examination of 30 shoulders showed newly formed bone at the resected clavicle in one third and radio-opaque deposits in the resection gap in another third. These findings were consistent with good outcome.

Acromioclavicular Joint↗
PubMed1987

Musculocutaneous nerve injury after coracoid process transfer for clavicle instability. Report of three cases.

During the last 10 years, we have treated 54 cases of fracture or dislocation of the lateral clavicle by transposing the coracoid process onto the clavicle. Recently, a postoperative musculocutaneous nerve injury was observed in 3 cases, all of which recovered spontaneously within 5 months. Our technique seems to entail a certain risk of causing stretch injury to the musculocutaneous nerve. Apart from resting the affected arm for a month or two, the condition does not require specific treatment.

Acromioclavicular Joint↗
PubMed1993

The natural course of lateral clavicle fracture. 15 (11-21) year follow-up of 110 cases.

110 patients with non-operated on fracture of the lateral end of the clavicle were reviewed on an average 15 years after the injury. There were 73 undislocated Neer Type I fractures, 23 dislocated Type II fractures and 14 intraarticular Type III fractures. The patients' age at trauma was 36 (2-71) years. At follow-up 95 shoulders were asymptomatic. 15 shoulders had moderate pain and dysfunction and were rated fair; no patient had severe, residual shoulder disability. There were 10 nonunions, 8 of these asymptomatic. We conclude that fracture of the lateral end of the clavicle does not require operation.

Adolescent↗
PubMed1986

Atraumatic osteolysis of the distal clavicle: histologic evidence of synovial pathogenesis. A case report.

Osteolysis of the distal clavicle was diagnosed in a young male athlete following many years as a baseball pitcher with a supplementary weightlifting program. There was no history of ligamentous injuries, contusions, fractures or separation of the acromioclavicular joint. As such, this case was categorized as "atraumatic" osteolysis. Non-decalcified histologic sections from the resected clavicle suggest that the pathogenesis of this atraumatic osteolysis arose from the synovium.

Adolescent↗
PubMed1986

Primary osteogenic sarcoma of the clavicle. A case report.

The clavicle is an unusual site for any primary bone tumor, including osteogenic sarcoma. A paucity of data in the literature on this type of lesion makes clear understanding of the optimal treatment difficult. Given its anatomical location, the lesion requires a multidisciplinary approach for optimal care, with each member of the health care team being important for maintaining and prolonging the quality of life for a patient. A 22-year-old man with primary osteogenic sarcoma of the clavicle was treated with preoperative and postoperative chemotherapy and was managed with surgical excision of the tumor while sparing the limb. Clinically disease-free for 20 months postoperatively, the patient presented with gross evidence of local recurrence with diffuse metastatic involvement at 22 months and died 6 weeks later. We have found no report of long-term survival on a patient with this lesion.

Adult↗
PubMed1998

Newborn clavicle fractures.

A prospective screening program of 9106 newborns identified 43 infants with clavicle fractures for a prevalence of 1 fracture in every 213 live births (0.5%). The fractures were equally distributed by right and left side involvement, and male and female sex. All fractures occurred during vaginal deliveries. None were breech presentation. Risk factors for fracture included large birth-weight, shoulder dystocia, mechanically assisted delivery, and prolonged gestational age. One in 11 newborns with a clavicle fracture also had a brachial plexus palsy.

Birth Injuries↗
PubMed2002

Factors associated with Short Form-36 outcomes in nonoperative treatment for ipsilateral fractures of the clavicle and scapula.

Twenty consecutive patients with ipsilateral fractures of the clavicle and scapula were treated nonoperatively with immobilization and physical therapy. Results were evaluated using the Herscovici, Rowe, and Constant scoring systems and the Short Form-36 (SF-36) questionnaire. The average comprehensive SF-36 score was lower than the scores obtained using the other scoring systems. In the SF-36 questionnaire, physical scores were strongly associated with nonphysical scores (P<.001). No association was found between SF-36 physical scores and age (P=.37), fracture pattern (clavicle, P=.81; scapula, P=.18), fracture displacement (P=.18), or injury severity score (P=.52). Outcomes were found to relate more to nonphysical factors than to the physical injury.

Adolescent↗
PubMed2003

Radiologic case study. Stress-induced osteolysis of the distal clavicle.

Repetitive stress-induced osteolysis of the distal clavicle occurs in athletes who engage in upper extremity weight strengthening exercises and occupational overuse. Repetitive microtrauma is believed to cause microfractures and bone resorption with local pain. Conservative treatment usually is effective. If conservative treatment is unsuccessful. excellent outcomes can be expected after open or arthroscopic resection of the distal clavicle.

Adult↗
PubMed1988

Fracture of the clavicle in the newborn. An ultrasound diagnosis.

Forty-one cases of clavicle fracture in newborn babies were examined by both radiographic and ultrasonic methods. No substantial difference has been found between these two modalities. It is suggested that ultrasound should be the procedure of choice in the diagnosis of clavicle fracture. This is especially true in those cases where impaired movement of the arm is the only clinical sign.

Birth Injuries↗