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Congenital Pseudoarthrosis of the Clavicle

clavicle pseudoarthrosis picture 

clavicle pseudoarthrosis picture

synonyms: clavicle pseudoarthrosis

Clavicle Pseudoarthrosis ICD-9

Clavicle Pseudoarthrosis Etiology / Epidemiology / Natural History

  • rare
  • 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, 5thgestational week
  • Only long bone to ossify be intramembranous ossification
  • Medial physis=80% of longitudinal growth
  • Both acromial and sternal physes can remain open into 3rddecade 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
  • painfree
  • 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)
  • neurofibromatosis
  • skeletal dyspasias

Clavicle Pseudoarthrosis Complications

  • infection
  • nonunion
  • 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

  • Activities as tolerated

Clavicle Pseudoarthrosis Review References

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