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