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Updated: Jun 30 2023

Congenital Pseudoarthrosis of Clavicle

Images pseudoarthosis of clavicle.jpg physical exam.jpg photo - colorado_moved.jpg
  • summary
    • Congenital Pseudoarthrosis of Clavicle is the failure of fusion of the medial and lateral ossification centers of the clavicle.
    • Diagnosis can be made with radiographs of the clavicle showing a rounded sclerotic bone at pseudoarthrosis site in the absence of trauma. 
    • Treatment is observation in the case of minimal symptoms and cosmetic deformity. Surgical management is indicated in the event of persistent pain or functional limitations. 
  • Epidemiology
    • Incidence
      • rare
    • Anatomic location
      • right side most common
        • situs inversus is the exception
        • bilateral in <10%
  • Etiology
    • Pathophysiology
      • postulated to be due to extrinsic compression by the subclavian artery
    • Genetics
      • no clear genetic involvement
  • Presentation
    • Symptoms
      • usually asymptomatic
    • Physical exam
      • inspection
        • painless, nontender mass on clavicle
        • may be associated with winging of scapula
  • Imaging
    • Radiographs
      • recommended views
        • AP of clavicle
      • findings
        • show rounded sclerotic bone at pseudoarthrosis site
  • Treatment
    • Nonoperative
      • observation
        • indications
          • minimal symptoms and cosmetic deformity
    • Operative - very uncommmon
      • ORIF with iliac crest bone grafting at age 3-6 years
        • indications
          • pain
          • functional impairment
          • cosmesis
        • outcomes
          • successful union is usually obtained
          • avoid bone graft substitute, higher rates of non-union
  • Prognosis
    • Usually is asymptomatic and does not require treament
    • If symptomatic, successful union predicted with surgical treatment
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