Congenital Pseudoarthrosis of Clavicle
Congenital Pseudoarthrosis of Clavicle (CPC) is a rare condition in which the two ossification centers of the clavicle fail to fuse. This can result in a painless, non-tender mass on the clavicle, and in some cases, winging of the scapula. CPC is usually diagnosed with radiographs of the clavicle, which will show a rounded sclerotic bone at the pseudoarthrosis site. Treatment for CPC is typically observation for patients with minimal symptoms and cosmetic deformity. Surgery may be necessary for patients with persistent pain or functional limitations. CPC is a rare condition, with an estimated incidence of 1 in 200,000 live births. It is more common in males than females, and the right side is more commonly affected than the left. Bilateral CPC is rare. The exact cause of CPC is unknown, but it is thought to be due to extrinsic compression of the clavicle by the subclavian artery. There is no clear genetic link to CPC. Most patients with CPC are asymptomatic. On physical exam, there may be a painless, non-tender mass on the clavicle. In some cases, there may be winging of the scapula. Radiographs of the clavicle are the recommended imaging study for CPC. Radiographs will show a rounded sclerotic bone at the pseudoarthrosis site. Treatment for CPC is typically observation for patients with minimal symptoms and cosmetic deformity. Surgery may be necessary for patients with persistent pain or functional limitations. Nonoperative treatment for CPC includes observation and pain management. Patients should avoid activities that may aggravate their symptoms. Operative treatment for CPC is typically open reduction and internal fixation (ORIF) with iliac crest bone grafting. Surgery is typically performed between the ages of 3 and 6 years. The prognosis for patients with CPC is generally good. Most patients are asymptomatic and do not require treatment. If surgery is necessary, successful union of the clavicle is usually obtained.Summary
Epidemiology
Etiology
Presentation
Imaging
Treatment
Nonoperative treatment
Operative treatment
Prognosis