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Congenital pseudoarthrosis of the clavicle (CPC) is a rare condition of unresolved etiology and pathogenesis. Familial occurrence of this anomaly has been documented but the pattern of genetic transmission remains obscure. Two cases involving a father and daughter are presented here with a review of the literature. These cases add support to the genetic basis for CPC.
A review of 78 patients (43 males, 25 females), aged 17-62, operated on for complicated fracture of the clavicle served to present indications and surgical techniques for this treatment. The use of a metal plate allows for stable fixation of the fracture, thus further management of patients with concomitant thoracic, pulmonary, or spinal injuries does not require plaster cast immobilization. Inaccurate fracture fixation with compression screw as being unstable necessitates plaster cast immobilization. Coexisting shoulder dislocation has been primarily managed surgically.
Clavicular fractures make up 45% of shoulder girdle fractures. The clavicle's susceptibility to injury is due to its subcutaneous position and its role as the bony connection between the thorax and the shoulder. In 95% of cases the mechanism of injury is a direct blow to the shoulder. These fractures are usually treated conservatively without surgery. But there are a few such fractures that require surgical repair in order to unite well. 9 patients were operated on for clavicular fractures during 1991-1995. The indications for surgical repair were lateral-third fracture, floating shoulder, neurovascular deficit or nonunion. The methods used were open reduction and fixation with either plate and screws, Kirchner wires, cerclage or a combination. All fractures united well, with no infections or new neurovascular deficits. Good range of shoulder motion and acceptable cosmetic results were achieved in all. 1 patient had functional limitation due to brachial neuritis caused by brachial damage at the time of injury. Indications for surgical repair and the methods used in these cases are similar to those described in the literature. The high rate of union and absence of complications support surgical repair for the few calvicular fractures that are not likely to unite properly.
Nonunions and malunions of the clavicle are uncommon but can be disabling, causing pain, limitation of shoulder motion or local brachial plexus compression. Reconstructive procedures are focused on gaining union and restoring functional clavicular anatomy. We would like to present a surgical procedure in which an autologous iliac crest graft and a 3.5 mm low contact-dynamic compression plate (LC-DCP) are used to regain clavicular stability and union. Surgery was performed in all eight patients for symptomatic nonunion. Eight patients treated by this method between 1991-1996 showed clinical and radiological union after an average follow-up time of eight months. All patients were highly satisfied with the surgical result. The advantages of the LC-DCP in the internal fixation of clavicular nonunions with its demanding anatomical and biomechanical characteristics are presented.
The authors present a rare case of transitory osteonecrosis of the humeral head with anterior instability of the glenohumeral joint, which occurred in a young male aged 19 years, three months after fracturing his clavicle in a fall. Core decompression of the humeral epiphysis and anterior capsulomioplasty according to Symeonides was performed. Five months after surgery the patient was clinically cured. After having excluded the possibility of metabolic imbalance in the patient, we presumed a direct relationship between the trauma and degenerative pathology affecting the humeral epiphysis.
Retrosternal dislocations of the clavicle have been reported previously in adults throughout the orthopedic literature. However, in children few cases have been noted in either the pediatric, emergency, or orthopedic literature. The potential for great vessel injury as well as acute airway compromise makes the retrosternal disruption of the sternoclavicular joint a surgical emergency that must be diagnosed quickly. Diagnosis is enhanced by the cephalic tilt view and by computed tomography (CT scan), as planar x-ray and tomography do not always reveal this potentially life-threatening condition. Surgical consultation must be sought acutely; however, management may need to begin prior to definitive repair. Emergency management begins by suspecting the injury, and with immediate airway and circulatory support for the patient.
In this report, we present 3 cases with thyroid carcinoma with tracheal invasion. In all cases, the tracheal defects were simultaneously reconstructed using a sternocleidomastoid muscle-clavicle myoosseous flap. We were able to close the tracheostomas without trouble, and no stenotic lesions or late complications were noted. This myoosseous composite flap has proved itself to be a reliable material for laryngotracheal reconstruction in some cases with thyroid carcinoma.
Traumatic posterior dislocation of the sternoclavicular joint is an unusual injury. We report a rare, late complication in the form of a thoracic outlet syndrome. Resection of the first rib resulted in prompt and complete resolution of the symptoms and would appear to be the appropriate treatment, avoiding the complications associated with resection of the clavicle.
A central venous port catheter inserted infraclavicularily via the subclavian route may be compressed by the clavicle and the adjacent first rib. It's appearance on chest x-ray has been previously described as the 'pinch-off phenomenon' and requires the removal of the catheter due to a significant risk of fracture. We report the case of a catheter fracture without prior evidence of pinch-off. The free catheter fragment was embolized into the right atrium and caused pericardial effusion. Percutaneous removal of the fragment was attempted but failed and thus open heart surgery with a cardiopulmonary bypass was required. The myocardial lesion caused by the catheter was sutured.
It's presented a case of the successive metastases in the right orbit with starting point a malignant melanoma skin located under the right clavicle. It's discussed the raruty situation of the malignant melanomas skin metastases in the orbit.
Retrosternal dislocation of the clavicle is an uncommon injury which may affect the mediastinal structures in a life-threatening way. Therefore, computed tomography is mandatory. Manipulation in the acute situation is the treatment of choice. In case of failure or old dislocation, open reduction with stabilization of the joint is required. The literature on this subject has been reviewed and an additional two cases are reported.
A 24-year-old man sustained a sporting accident which caused the contour of the proximal part of the right clavicle to disappear, due to a posterior sternoclavicular dislocation.
A case of post traumatic bipolar dislocation of the clavicle is reported. Only acromio-clavicular joint was reduced and fixated surgically. The result is good. This injury is rare and treatment is controversial.
We treated six patients who had a dislocation of both ends of the clavicle (an anterior dislocation of the sternoclavicular joint and a posterior dislocation of the acromioclavicular joint). Two patients who had fewer demands on the shoulder--an elderly woman and a woman who had had an ipsilateral amputation of the hand--did well; they had only minor symptoms after non-operative management. The other four patients (all men) had continuing pain at the acromioclavicular joint; each had a reconstruction of the joint, which resulted in a painless, full range of motion and return to normal activity. No patient had continuing pain in the sternoclavicular joint.
An apparatus for reposition and fixation of the clavicle in case of the dislocation, in the acromioclavicular joint is described. The method was used in the treatment of 60 patients. There were 57 good results, and in 3 cases the results were fair.
A review of the literature on acute traumatic retrosternal dislocations of the clavicle revealed that closed reduction often fails. In six of our seven patients retraction of the shoulders with caudal traction on the adducted arm, while the patient was supported by an interscapular bolster, achieved reduction of the dislocation. We analyzed the mechanism of this and other methods of closed reduction.
We describe a case of osteoid osteoma of the clavicle in an Olympic free-style wrestler who presented to us with persistent and increasingly elevated pain in his right shoulder. Originally a persistent injury was considered to be causing the pain, however, the correct diagnosis was made three months after the onset of the symptoms. Even in sportsman where muscle pain is commonplace, non-traumatic conditions should be considered in the presence of persistent and increasingly elevated pain that is not relieved by rest and physiotherapy.
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