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Congenital Pseudoarthrosis of the Clavicle, MedPixô : 9858 - Medical Image Database and Atlas
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More Like This ? MSK - Musculoskeletal
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More Like This ? Congenital, malformation
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More Like This ? Congenital Pseudoarthrosis of the Clavicle
Topic 9858 - Created: 2011-12-09 14:50:01-05 - Modified: 2011-12-10 08:06:18.254288-05
ACR Index: 4.0

Congenital pseudarthrosis of the clavicle is a rare entity that occurs secondary to failure of normal fusion of the medial and lateral ossification centers of the clavicle. This occurs in the right clavicle almost exclusively, execept in cases of situs inversus or dextrocardia. Unlike other causes of pseudoarthrosis, this is not secondary to trauma, birth trauma, neurofibromatosis, or fibrous dysplasia.

Patients present with a nontender prominence or lump overlying the mid right clavicle. This prominence becomes more obvious as the patient continues to grow. The ends of the clavicular segments are enlarged and demonstrates motion which also increases with age. On radiologic examination, there will be a rounded appearance of the clavicular fragments. No callous formation will be seen with this type of pseudarthrosis.

Differential diagnosis includes trauma with nonunion of past clavicular fracture, which may occur amongst young children and occurs in the midshaft of the clavicle in 80% of cases. Another consideration is cleidocranial dysplasia which may present with absence of the central midshaft portion of the clavicle. In these cases, there may be small medial and lateral portions of the clavicle remaining. In cases of Cleidocranial dysplasia, the patient should also exhibit other skeletal abnormalities, which may include but are not limited to small facial bones, scoliosis and pelvis deficiencies, and skull deformities. Pseudoarthrosis associated with neurofibromatosis occurs almost exclusively in the tibia. Neurofibromatosis patients also often exhibit caf–Ļ-au-lait skin lesions. Other possibilities include pseudoarthrosis from fibrous dysplasia or osteogenic imperfecta.

Treatment depends on the individual case. Since the patient may have little or no associated pain, no treatment may be necessary. However, patients often present with a visible lump over the midshaft of the clavicle and may have diminished functional capacity. Patients may elect to have orthopedic surgical correction with Open Reduction and Internal Fixation (ORIF) and possible bone grafting.

Contributor Credits

Topic Submitted by: Chris C Ryen - Author Info
Affiliation: Childrens Hospital of Dayton, OH
Topic approved by: Dawn E Light - Editor Info
Affiliation: Childrens Hospital of Dayton, OH

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