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The isolated congenital non-union of the clavicle is an extremely rare condition. We report on of one case of bilateral congenital non-union of the clavicle in which the left side became painful. Treatment with compression plate osteosynthesis and homologous cancellous bone grafting was successful. Surgical treatment of this rare condition is only indicated when the non-union becomes painful.
A case of congenital pseudarthrosis of the clavicle is presented. Congenital pseudarthrosis of the clavicle is an entity that has rarely been recorded in the radiological literature. The etiology of the condition remains obscure. The radiographic appearance is characteristic.
The association pseudarthrosis of the clavicle and the thoracic outlet syndrome is rare. The author describe a case in a 64 years old man, found before embolic complications. Shoulder X-ray and artériography démonstrate the lesion. The etiopathogenic hypothesis are called up. In case of complication, the surgical treatment is made of osteo synthesis or partial or total resection of the clavicle, associated to a vascular repair in case of need. At long term the result is excellent.
The sternal ends of right clavicles of Japanese aged 13-31 years (n = 54) autopsied during 1982-1992 were observed for determining degree of epiphyseal union to establish a criterion for age estimation. As the degree of union 5 stages (McKern and Stewart, 1957) were applied to samples: Stage 0; without any union between the trunk and the epiphyseal cap, stage 1; between stage 0 and stage 2, stage 2; half united, stage 3; between stage 2 and stage 4, and stage 4; completely united. As results, in females union appears to proceed faster than in males. There were cases in which union reached stage 4 in younger ages. As a criterion for age estimation it is proposed at present that in both sex, when union is in stage 0, age is certainly estimated to be less than 22 years old and in stage 4, more than 19 years old. Comparing the present data with the investigation about American males by McKern and Stewart (1957), in Japanese males union proceeds more fast than them. The authors realized that the correct criteria should be used in age estimation on a sample belonging to the same race and to the times. The clavicles in skeletal remains tend to be preserved outdoors and are suitable for estimating age from adolescence to about 30 years old. Therefore the present criterion would be very useful in districts such as Hokkaido where skeletal remains are commonly found.
Epiphyseal fracture-retrosternal dislocation of the medeial end of the clavicle is an unusual injury. It may occur as a result of a blow either indirectly on the posterolateral aspect of the shoulder girdle or directly over the sternal end of the clavicle. It is clinically impossible to differentiate from the true posterior dislocation even with the computed tomography, but the treatment for either lesion is the same. Recently we uneventually treated a 15-year-old boy with conservative treatment and got a satisfactory result. The purpose of this paper is to draw the attention of the readers to the rarity and serious nature of such injury and the potential difficulties in establishing diagnosis and achieving reduction.
Painful conditions of the acromioclavicular joint without instability can be treated successfully with arthroscopic methods. The direct approach is best suited for isolated acromioclavicular pathology. It also can be used to address the acromioclavicular joint during shoulder arthroscopy and bursoscopy, but two additional acromioclavicular portals are needed. In patients with both subacromial and acromioclavicular joint pathology, the bursal approach to the acromioclavicular joint can be used. In some patients with narrow or medially inclined overriding clavicles, the distal clavicle is not easily resected with the bursal approach. The direct approach is an alternative in these situations. Either method has been shown to be an effective treatment and can return the patient to full activity much sooner than with a traditional open resection.
Two cases of osteitis condensans of the medial clavicle with an unusual course toward spontaneous resolution of clinical and roentgenographic manifestations are reported. The relevant literature is reviewed. A pathogenic hypothesis for condensing osteitis of the clavicle, ilium, and pubis is suggested. At all these sites, the sclerosis occurs in bone overlaid by fibrocartilage. In contrast, joint aspects spared by the sclerosis are covered with hyaline cartilage. We report data documenting this fact at the sternoclavicular joint.
Fracture of the clavicle is a common injury that usually heals without consequence. Instability of the scapulothoracic articulation does not usually occur. In this case, the scapulothoracic subluxation was not obvious at the time of injury, but progressively worsened over the following 2 weeks. Open reduction and internal fixation of the clavicle fracture restored stability to the shoulder girdle. The patient went on to regain full function of her injured extremity.
We report a case of an aneurysmal bone cyst (ABC) of the clavicle in a 9-year-old boy, which initially presented as a pathological fracture of a benign cystic lesion. ABC of the clavicle is rare in children less than 10 years old and radiological diagnosis may prove difficult in the early stages of presentation.
We report on two children who developed a fixed rotatory subluxation of the atlantoaxial joint due to torticollis being attributed to a fractured clavicle. Appropriate treatment was delayed for weeks to months; only after the fractured clavicle had healed and the torticollis persisted was the problem identified. Persisting rotatory subluxation also predisposes to further anterior displacement of C-1 due to an increased moment arm created by the forward displacement of the center of gravity of the head. The association of atlantoaxial subluxation should always be considered in children presenting with a clavicular fracture and an acute torticollis.
Osteitis condensans of the clavicle is a rare condition characterized by pain in the shoulder and often limitation of motion of the shoulder. The medical history and results of the physical examination, laboratory data, and radiographic studies (including computed tomography and magnetic resonance imaging), often establish the diagnosis. Patients who have slight or no pain usually require no treatment. Varying results have been reported for many different methods of treatment, including surgical excision, chemotherapy, antibiotics, nonsteroidal anti-inflammatory medications, radiation, local corticosteroid injection, and physical therapy. A typical case report and the differential diagnosis for condensing osteitis of the clavicle are presented.
BACKGROUND: Tumescent local anesthesia has been adapted for surgery of the face and neck, but there are no data regarding drug absorption when tumescent injection is used in this region. The aim of this study was to characterize the changes in plasma lidocaine concentrations over time when a tumescent solution is injected into the subcutaneous tissue of the neck. The study was carried out in human volunteer subjects, and injection of lidocaine to the thighs provided control data. METHODS: Eight healthy female volunteer subjects were studied twice using a prospective, crossover design. Tumescent lidocaine solution was injected into the subcutaneous tissue of the neck in one session and the thighs in another session. The order of injection was randomized. Blood samples were collected for 14 hours after injection, and the plasma concentration of lidocaine measured. The injected solution consisted of lidocaine 0.1%, NaHCO3 12.5 mEq/L, and epinephrine 1:1,000,000 in normal saline. A standardized dose of lidocaine (7 mg/kg) was used for each injection and no surgical procedure was performed. RESULTS: All subjects completed the study. Subject weight was 66.1 +/- 12.8 kg, body fat was 29.0 +/- 4.7 percent, and body mass index was 23.8 +/- 3.1 kg/m2. The average time to reach peak lidocaine concentration after neck injection was 5.8 hours, whereas peak lidocaine concentration after thigh injection did not occur until 12.0 hours. This difference of 6.2 hours was highly significant (p = 0.009). The average peak concentration after neck injection was 16 percent greater than that after thigh injection (0.94 microg/ml versus 0.81 microg/ml), with the difference approaching significance (p = 0.06). No adverse reactions were noted. CONCLUSIONS: Tumescent injection above the clavicles results in a rapid rise in plasma lidocaine concentration when compared with injection to the lower extremities. Toxic symptoms could occur much earlier than expected for lower extremity tumescent anesthesia. In addition, dangerous plasma levels could occur if tumescent anesthesia in the lower extremities is followed by tumescent injection above the clavicles, because the absorption curves would be superimposed.
The acromioclavicular joint is commonly affected by traumatic and degenerative conditions. Most injuries are due to direct trauma, such as a fall on the shoulder. Six types of acromioclavicular sprains and three types of distal clavicle fractures have been described in adults. Although there is general agreement on treatment of type I, II, IV, V, and VI acromioclavicular injuries, the treatment of type III injuries remains controversial. Studies have shown no distinct advantage for surgical reconstruction over nonoperative treatment. Because type II distal clavicle fractures are prone to nonunion, operative fixation may be advisable to avoid this complication.
The cause of pseudarthrosis of the clavicle is obscure. Right-sidedness is an almost constant feature. We have proposed that the lesion is sometimes due to pressure upon the developing clavicle by the subclavian artery which is normally at a higher level on the right side. This may be accentuated in the presence of cervical ribs or unduly elevated first ribs, both of which we have observed in association with pseudarthrosis. We have also noted pseudarthrosis on the left side in association with dextrocardia (when the relative positions of the subclavian arteries are reversed) and in the presence of a large left cervical rib. We have speculated upon the nature of the clavicular defect in cranio-cleido dysostosis, in which disorder the first ribs are habitually elevated. A similar mechanism may be involved.
Atraumatic retrosternal dislocation of the clavicle is an exceedingly rare event and three out of four previously reported cases lack any radiological evidence. We report the case of a 30-year-old male patient who presented an atraumatic retrosternal dislocation of the clavicle without a history of previous injury and underlying pathology. The diagnosis was delayed and established by a CT scan ten days after and initial presentation of the symptoms. A successful, stable, closed reduction under general anaesthesia was performed ten days after the initial presentation, having a cardiothoracic surgeon immediately available. There was no recurrence and the patient remains asymptomatic 18 months later.
The histological method developed by Stout and Paine ([1992] Aln. J. Phys. Antropol. 87:111-115) for estimating age at death using the clavicle is tested on a known age independent sample from a nineteenth century cemetery near Spitalfriedhof St. Johann in Basel, Switzerland. The mean absolute difference between reported ages and histologically predicted ages is 5.5 years. Mean predicted age for the sample is different from mean reported age. This difference is accounted for by differences in the age distributions between the original autopsy sample used to derive the histological age-predicting formula and the cemetery sample, and an inherent loss of reliability of histological age predictions for the skeletal remains of older individuals. A new formula based upon the combined original autopsy sample of Stout and Paine (1992) and the Swiss cemetery sample is presented. It is recommended that this formula be used when estimating ages for older individuals or archaeological skeletal samples.
The first definitive hominoid from the Libyan Mio-Pliocene site of Sahabi is described. The specimen is a left clavicle, lacking a portion of the acromial end. In superior view it shows a marked sternal curvature, similar to homonids, but it also shows a curvature in the coronal plane, similar to the pongid condition. Muscle attachments for sternocleidomastoid, pectoralis major and the anterior portion of deltoid are preserved. The robust attachment for the latter suggests relative hypertrophy of this muscle. These considerations and certain morphological similarities to hominids do not suggest a functional reconstruction of locomotor behavior similar to Miocene dryopithecines. Nevertheless, more complete functional and taxonomic discussions must await further work at Sahabi.
Epiphyseal union of the anterior iliac crest and the medial clavicle is examined in 605 males and 254 females in a sample of modern Americans aged 11-40 years. The sample includes American whites, American blacks, Latin-Americans, and Orientals. This is the first skeletal investigation using a large sample of individuals of known age since the McKern and Stewart study of 1957. Epiphyseal union is analyzed in terms of four stages: 1) nonunion with no epiphyses, 2) nonunion with separate epiphyses, 3) partial union, and 4) complete union. The results provide broader age ranges for the stages of union than previous studies. Age ranges for males and females are similar or vary by only 1-2 years. Racially, no major distinguishing patterns are found except for greater variability in age distributions appearing to exist among American black females. The study furnishes valuable data on epiphyseal timing in the teenage years.