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Post-traumatic osteolysis (PTOL) is a very rare disease occurring after acute trauma or repetitive micro-trauma, which is characterized by persistent pain in the injured site. In this study, we reported 7 patients, in whom osteolysis developed in the distal clavicle, pubis and ischium.
In a retrospective study, 12 patients with acute acromioclavicular dislocation Tossy stage III were reviewed after operative treatment with a clavicle hook plate. Mean follow-up time was 20 months. Clinical and radiographic results were reviewed. Clinical outcome was superior to the radiographic results. Some questions about this technique remain open.
Fractures of irradiated bones present special challenges to healing. Nonunions are very common and are challenging surgical problems. We report three radiated nonunions of the clavicle successfully treated with modifications of standard internal fixation techniques.
Degenerative change involving the acromioclavicular (AC) is frequently seen as part of a normal aging process. Occasionally, this results in a painful clinical condition. Although AC joint symptoms commonly occur in conjunction with other shoulder pathology, they may occur in isolation. Treatment of isolated AC joint osteoarthritis is initially non-surgical. When such treatment fails to provide lasting relief, surgical treatment is warranted. Direct (superior) arthroscopic resection of the distal (lateral) end of the clavicle is a successful method of treating the condition, as well as other isolated conditions of the AC joint. The following article reviews appropriate patient evaluation, surgical indications and technique.
This report presents an extremely rare case of extraskeletal myxoid chondrosarcoma (EMC) arising from the clavicular periosteum. To the best of our knowledge, this may be the first detailed report of its clinicopathological findings. The patient was a 48-year-old man. Plain radiography and CT did not demonstrate any osteolytic lesion or periosteal reaction in the right clavicle. However, MRI showed an isosignal-intensity mass on T1-weighted images and a homogeneous high signal intensity lesion on T2-weighted images. The histological findings of the widely resected tumor were consistent with the diagnosis of extraskeletal myxoid chondrosarcoma. Preoperative diagnosis of extraskeletal myxoid chondrosarcoma at an unusual location, as in this case, is difficult not only with imaging examinations alone, but sometimes even after histological examination of biopsy specimens.
A new case of congenital nonunion of the clavicle is reported with a histological description. Medullar drilling and bone grafting "in loco" was performed during the surgical procedure. The etiologic hypotheses are discussed. The authors compare congenital nonunions between the pathologies associated with the necessity of medullar drilling for consolidation.
A case of aseptic necrosis of the medial segment of the clavicle with X-ray images of fragmentation and few clinical symptoms is presented. This condition develops spontaneously and leads to early sternoclavicular osteoarthritis. The benign nature of the disease and the absence of treatment make it important to establish the correct diagnosis, differentiating it from other disorders in this area.
The bone alterations in the region of the clavicle (3 cases) are similar to those we have observed and described elsewhere in the skeleton i.e., the mandible, maxillary and ethmoid bones. Rarefaction is the result of three different types of bone destruction: osteoclasia, a kind of osteocytic osteolysis only observed after irradiation and obviously related with infection, and a pure demineralization of the osseous tissue by contact with pus. Reconstruction processes, although unable to prevent spontaneous fracture, are also present and correspond to islets of chondroid tissue surrounded by lamellar bone. However, these recently deposited calcified tissues are already necrotic since most of their lacunae are empty.
The study reports a rate case of a girl with associated clavicular fracture and acromioclavicular dislocation following a care accident. The pathogenetic mechanism may be attributed to a trauma on the medial shoulder stump which having fractured the clavicle then provoked the acromioclavicular dislocation by continued pressure on that point. It is important to observe that the patient fully recovered, virtually without therapy.
Sprengel's deformity is the most common congenital anomaly of the shoulder girdle and is often accompanied by the presence of an omovertebral bone. Preoperative oblique roentgenograms or computed tomography may be necessary to define the abnormal structures in Sprengel's deformity. Sprengel's deformity in a six-year-old girl was corrected as follows. During clavicular exposure to osteotomy, an abnormal osseous bridge extending from the midportion of the clavicle to the spine of the scapula was identified and resected. A literature survey failed to identify other similar anomalies.
Fractures of the clavicle are usually treated by closed means and heal uneventfully. In this report, we present an unusual case in which the subclavian vein was compressed by a fracture callus that had formed around a clavicular nonunion. Treatment included dissection of the subclavian vein from the fracture callus and compression plating with autogenous bone grafting of the fracture. Symptoms from the patient's venous obstruction slowly resolved without further treatment. The fracture united postoperatively.
Aggressive treatment of the multiply injured patient often requires early fixation of many fractures, some of which may be open. Often, patients develop postoperative fevers requiring a thorough workup to rule out infection. Recently, indium-111 white blood cell (WBC) imaging has become a valuable adjunct in the diagnosis of acute infection. The patient described had a simple, closed clavicle fracture with markedly increased activity on an indium-111 WBC scan obtained for fever workup. This subsequently proved to be a normal, healing, noninfected fracture by other diagnostic techniques. Noninfected, simple closed fractures should be added to the list of causes for a false-positive indium-111 WBC scan.
Fractures of the clavicle are a common lesion best treated by closed means. In the unusual instance that nonunion develops or early irreversible vascular or neurologic compromise is present, an intramedullary Knowles pin is the preferred method of fixation. Injuries of the acromioclavicular joint usually can be treated symptomatically. Types 3A and B require early operative intervention. For the few patients who have late symptoms from types 2 or 3, an acromioclavicular arthroplasty, joint stabilization, and transference of the coracoacromial ligament to form a superior acromioclavicular ligament are used.
Twenty-three patients who had a clavicular non-union were treated operatively at the Massachusetts General Hospital from 1974 to 1985. Twenty-one non-unions were the result of fracture and two, secondary to osteotomy. Twenty non-unions were located in the middle third of the clavicle, while three were in the lateral third. Radiographically, eighteen non-unions were atrophic and three, hypertrophic. Two non-unions resembled pseudarthrosis. Of the etiological factors that were reviewed the extent of displacement of the original fracture was the most significant. Associated complications of the non-union included limited mobility of the shoulder in fourteen, neurological symptoms in eight, thoracic outlet syndrome in four, and arterial ischemia in one. Of the nineteen patients who were treated to obtain union, seventeen had a successful result at an average length of follow-up of 23.8 months. In sixteen (93.7 per cent) of the seventeen patients union was achieved by fixation with a plate; one patient required two procedures. Ancillary bone graft was used in eighteen patients, with three requiring a sculptured bicortical graft from the iliac crest to span a defect. Of the four other patients three were treated with a partial clavicular resection and one, with complete clavicectomy.
Pinning of fractures of the clavicle is easily and safely done by introducing the pin through the medial fragment. The pointed tip is embedded into the cortex of the lateral fragment and the inner end of the pin is bent at a right angle to fix it to the bone. Insertion is made with image intensification to avoid vascular damage and to guide the passage of the pin through the medial fragment without danger. Of 25 fractures treated in this way, only two, treated at the beginning of the series, required open reduction. No other immobilisation was necessary. All the fractures united uneventfully.
A rare injury of the clavicle and its articulations is reported. A possible mechanism of injury is suggested, and the management and outcome are discussed. The importance of being on the look-out for the potentially lethal posterior dislocation of the sternoclavicular joint is stressed.
Review of the literature reveals that postradiation chondrosarcoma is a rare secondary malignant bone tumor. This case report demonstrates a Grade 1 chondrosarcoma of the proximal right clavicle in a 17-year-old boy, eight years after extensive chemotherapy and radiation therapy for a Stage IIB Hodgkin's disease.
Kirschner pins are widely used for fixation of bone, with few and very rarely serious complications. A case is described in which a Kirschner pin migrated in 10 days from the sternal end of the left clavicle into the lumen of the ascending aorta. The exact location of the pin remained unknown until right thoracotomy, during which X-ray examination revealed the unexpected situation. The pin was simply extracted by pushing it through the vessel wall. The patient recovered uneventfully. The complication could have been prevented by bending the outer part of the pins. The possible route of migration is discussed.