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Congenital Pseudoarthrosis of Clavicle

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Topic updated on 01/27/14 8:47am
Introduction
  • Congenital failure of fusion of the medial and lateral ossification centers of the clavicle
  • Epidemiology
    • incidence
      • rare 
    • location
      • right side most common q
        • situs inversus is the exception
        • bilateral in <10%
  • Pathophysiology
    • postulated to be due to extrinsic compression by the subclavian artery 
  • Genetics
    • no clear genetic involvement 
  • Prognosis
    • successful union predicted with surgical treatment
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
    • 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

 

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(OBQ04.179) Congenital pseudoarthrosis of the clavicle almost always presents on: Topic Review Topic

1. the right side, middle 1/3
2. the right side, lateral 1/3
3. the left side, middle 1/3
4. the left side, lateral 1/3
5. both sides equally

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