eMedicine Specialties > Orthopedic Surgery > Pediatrics

Congenital Pseudoarthrosis of the Clavicle: Treatment

Author: L Andrew Koman, MD, Professor, Chair, Department of Orthopedic Surgery, Wake Forest University School of Medicine
Contributor Information and Disclosures

Updated: Jun 11, 2008

Treatment

Medical Therapy

Mere observation may be appropriate. No nonoperative techniques achieve union.

Surgical Therapy

Surgical intervention is indicated for pain, appearance that negatively impacts self-esteem, and shoulder deformity interfering with function.13

Preoperative Details

After taking a general history and performing a physical examination, evaluate the right upper extremity for range of motion, stability, and neurovascular function. The patient should be prepared for surgery, and the entire right upper limb prepared free to facilitate mobilization of the clavicle and to observe for neurovascular problems. Prophylactic antibiotics are appropriate if internal fixation is employed. A semisitting or beachchair position may be helpful to obtain exposure.

Intraoperative Details

Surgical steps are as follows:

  • Expose the clavicle through a transverse incision.
  • Control bleeding with electrocautery.
  • Expose the medial and lateral clavicle subperiosteally, excise the sclerotic ends, and resect the pseudoarthrosis.
  • Determine if end-to-end repair is possible.14 If not, use a bone graft.
  • Apply an appropriate-sized compression plate.
  • Reapproximate the periosteum.
  • Close the wound in layers.

Postoperative Details

Postoperatively, the patient is immobilized in a sling and swath; alternatively, a shoulder spica may be used for small children if internal fixation is inadequate.15 The clavicle is protected until union is confirmed clinically and radiographically.

Complications

The major surgical complication is failure of the clavicle to unite. However, in contradistinction to congenital pseudoarthrosis secondary to neurofibromatosis, union is common.

Hardware is removed if painful or unduly prominent. Neurovascular injury is rare but may occur. Infection may occur in the postoperative period.

More on Congenital Pseudoarthrosis of the Clavicle

Overview: Congenital Pseudoarthrosis of the Clavicle
Workup: Congenital Pseudoarthrosis of the Clavicle
Treatment: Congenital Pseudoarthrosis of the Clavicle
Follow-up: Congenital Pseudoarthrosis of the Clavicle
References
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References

  1. Beals RK, Sauser DD. Nontraumatic disorders of the clavicle. J Am Acad Orthop Surg. Apr 2006;14(4):205-14. [Medline].

  2. Gibson DA, Carroll N. Congenital pseudarthrosis of the clavicle. J Bone Joint Surg Br. Nov 1970;52(4):629-43. [Medline].

  3. Cataldo F. A 7-month-old child with a clavicular swelling since birth. Diagnosis: congenital pseudarthrosis of the clavicle. Eur J Pediatr. Dec 1999;158(12):1001-2. [Medline].

  4. Ettl V, Wild A, Krauspe R, Raab P. Surgical treatment of congenital pseudarthrosis of the clavicle: a report of three cases and review of the literature. Eur J Pediatr Surg. Feb 2005;15(1):56-60. [Medline].

  5. Jeon IH, Wilson I, Wallace WA. Reconstruction of congenital pseudarthrosis of the clavicle in an adult. J Orthop Sci. Mar 2006;11(2):229-31. [Medline].

  6. Shalom A, Khermosh O, Wientroub S. The natural history of congenital pseudarthrosis of the clavicle. J Bone Joint Surg Br. Sep 1994;76(5):846-7. [Medline].

  7. Owen R. Congenital pseudarthrosis of the clavicle. J Bone Joint Surg Br. Nov 1970;52(4):644-52. [Medline].

  8. Alldred AJ. Congenital Pseudoarthrosis of the clavicle. J Bone Joint Surg Br. 1963;45B:312.

  9. Ahmadi B, Steel HH. Congenital pseudarthrosis of the clavicle. Clin Orthop. Jul-Aug 1977;(126):129-34. [Medline].

  10. Mooney JF, Koman LA. Bilateral congenital pseudarthrosis of the clavicle associated with trisomy 22. Orthopedics. Feb 1991;14(2):171-3. [Medline].

  11. Gomez-Brouchet A, Sales de Gauzy J, Accadbled F, Abid A, Delisle MB, Cahuzac JP. Congenital pseudarthrosis of the clavicle: a histopathological study in five patients. J Pediatr Orthop B. Nov 2004;13(6):399-401. [Medline].

  12. Sloan A, Paton R. Congenital pseudarthrosis of the clavicle: the role of CT-scanning. Acta Orthop Belg. Jun 2006;72(3):356-8. [Medline].

  13. Schnall SB, King JD, Marrero G. Congenital pseudarthrosis of the clavicle: a review of the literature and surgical results of six cases. J Pediatr Orthop. May-Jun 1988;8(3):316-21. [Medline].

  14. Grogan DP, Love SM, Guidera KJ. Operative treatment of congenital pseudarthrosis of the clavicle. J Pediatr Orthop. Mar-Apr 1991;11(2):176-80. [Medline].

  15. Beslikas TA, Dadoukis DJ, Gigis IP, Nenopoulos SP, Christoforides JE. Congenital pseudarthrosis of the clavicle: a case report. J Orthop Surg (Hong Kong). Apr 2007;15(1):87-90. [Medline].

  16. Sakkers RJ, Tjin a Ton E, Bos CF. Left-sided congenital pseudarthrosis of the clavicula. J Pediatr Orthop B. Jan 1999;8(1):45-7. [Medline].

  17. Sales de Gauzy J, Baunin C, Puget C. Congenital pseudarthrosis of the clavicle and thoracic outlet syndrome in adolescence. J Pediatr Orthop B. Oct 1999;8(4):299-301. [Medline].

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Further Reading

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Keywords

congenital failure of formation clavicle, shoulder deformity, chest deformity, dextrocardia, situs inversus, neurofibromatosis, pseudarthrosis

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Contributor Information and Disclosures

Author

L Andrew Koman, MD, Professor, Chair, Department of Orthopedic Surgery, Wake Forest University School of Medicine
L Andrew Koman, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Orthopaedic Surgeons, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, Clinical Orthopaedic Society, Eastern Orthopaedic Association, North Carolina Medical Society, North Carolina Medical Society, Orthopaedic Research Society, Pediatric Orthopaedic Society of North America, Sigma Xi, Southern Medical Association, and Southern Orthopaedic Association
Disclosure: Allergan Grant/research funds study investigator;  Wright Medical  Consulting fee Researcher

Medical Editor

Mininder S Kocher, MD, MPH, Associate Professor of Orthopedic Surgery, Harvard Medical School/Harvard School of Public Health; Associate Director, Division of Sports Medicine, Department of Orthopedic Surgery, Children's Hospital Boston
Mininder S Kocher, MD, MPH is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the History of Medicine, American Medical Association, American Orthopaedic Society for Sports Medicine, and Massachusetts Medical Society
Disclosure: Smith & Nephew Endoscopy Consulting fee Consulting; ConMed Linvatec Consulting fee Consulting; Covidian Consulting fee Consulting; EBI Biomet Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

George H Thompson, MD, Director, Pediatric Orthopedics, Rainbow Babies and Children's Hospital
George H Thompson, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dennis P Grogan, MD, Clinical Professor, Department of Orthopedic Surgery, University of South Florida College of Medicine; Chief of Staff, Department of Orthopedic Surgery, Shriners Hospital for Children of Tampa
Dennis P Grogan, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Eastern Orthopaedic Association, Irish American Orthopaedic Society, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society
Disclosure: Nothing to disclose.

 
 
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