Congenital Pseudoarthrosis of the Clavicle
synonyms: clavicle pseudoarthrosis
Clavicle Pseudoarthrosis ICD-9
Clavicle Pseudoarthrosis Etiology / Epidemiology / Natural History
- etiology unknown, theories=intrinsic failure vs compression
- subclavian artery may compress developing right clavicle which might explain right sided predominance and occurrence on left with dextrocardia
- 90% right sided.
- no association with neurofibromatosis
- most are right sided, 10% bilitaeral,(associated with cervical ribs) rarely left sided.
- right > left
- rare to be bilateral
Clavicle Pseudoarthrosis Anatomy
- First bone to ossify, 5th gestational week
- Only long bone to ossify be intramembranous ossification
- Medial physis=80% of longitudinal growth
- Both acromial and sternal physes can remain open into 3rd decade of life.
- See also Shoulder Anatomy.
Clavicle Pseudoarthrosis Clinical Evaluation
- prominent, palpable mobile, middle third of the clavicle at birth of soon after
- shoulder appears dropped, arm slightly closer to midline
- normal shoulder ROM
- no hx of trauma or tenderness
Clavicle Pseudoarthrosis Xray / Diagnositc Tests
- osseous separation of clavicle with enlarged, rounded ends without fracture callus
Clavicle Pseudoarthrosis Classification / Treatment
- generally non-operative. Spontaneous bony union does not occur, but patients generally have minimal pain and normal function.
- Rare but potential complications: pain at pseudoarthrosis site, shoulder asymmetry, decreased motion, thoracic outlet syndrome.
- Surgery indicated only for severe prominence after appropriate PT counseling
- Surgerical options:
-Infant: resection of fibrous tissue/sclerotic bone with periosteal repair
-Children (prepubertal): excision of pseudoarthrosis, grafting and plating.
-Adults (postpubertal): excision of prominence without ORIF.
Clavicle Pseudoarthrosis Associated Injuries / Differential Diagnosis
- traumatic clavicle fx
- cleidocranial dysostosis(AD, paritial or total absence of the clavicle, frontal bossing, diastasis of pubic symphysis)
- skeletal dyspasias
Clavicle Pseudoarthrosis Complications
- brachial plexus injury
- Rare but potential complications of non-op treatment: pain at pseudoarthrosis site, shoulder asymmetry, decreased motion, thoracic outlet syndrome.
Clavicle Pseudoarthrosis Follow-up Care
Clavicle Pseudoarthrosis Review References