Congenital Pseudoarthrosis of Clavicle - Diagnosis and Treatment

Congenital Pseudoarthrosis Clavicle - Diagnosis and Treatment

Congenital Pseudoarthrosis of Clavicle is the failure of fusion of the medial and lateral ossification centers of the clavicle.

Diagnosis

Diagnosis can be made with radiographs of the clavicle showing a rounded sclerotic bone at pseudoarthrosis site in the absence of trauma.

Treatment

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: 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

• 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 treatment. If symptomatic, successful union predicted with surgical treatment.