Operative treatment of congenital pseudarthrosis of the clavicle: a single-centre experience

Abstract

Congenital pseudarthrosis of the clavicle (CPC) is a very rare condition with a predilection for the right clavicle. Young children are often only symptomatic with activities and as they grow. Operative management in an asymptomatic child is debatable, with various techniques reported in the literature. This is a retrospective, single-centre case series study. All children with CPC treated surgically by resection, bone grafting (nonvascular iliac crest) and plate fixation between 2004 and 2012 at our centre were included. Excluded conditions were traumatic or obstetric fractures of the clavicle, children with musculoskeletal or neurological disorders and children lost to follow-up. Clinical and radiological examination was performed at 6 weeks, 3 months and between 6 and 12 months postoperatively. A total of eight clavicles in seven children (four girls and three boys), with a mean age of 7.1 years (5–8 years), were operated with a mean follow-up of 7 years (4–10 years). In six children, the right (dominant) side was affected, with one child affected bilaterally. Overall, 85% of our patients showed good functional results 6 weeks postoperatively and complete radiographic consolidation at a mean of 8.5 months (3–25 months) postoperatively. One female child showed delayed union, but without clinical deficit. There was low donor-site morbidity. We recommend early operative treatment of CPC with a nonvascularized bone graft from the iliac crest and plate fixation. Level of Evidence: IV.