Pediatric Clavicle Fractures and Congenital Pseudarthrosis Unraveled

Abstract

Clavicle fractures are commonly seen in the pediatric and adolescent populations. In contrast, congenital pseudarthrosis of the clavicle is rare. Although both conditions may present with similar signs and symptoms, especially in the very young, clear differences exist. Clavicle fractures are often caused by trauma and are tender on palpation, while pseudarthrosis often presents with a painless protuberance on the clavicle, which becomes more prominent as the child grows. Its presence may only become apparent after trauma, as it is usually asymptomatic. The diagnosis is confirmed on plain radiography, which shows typical features to distinguish both entities. Both clavicle fractures and congenital pseudarthrosis are generally treated conservatively with a high success rate. Operative treatment for a fracture can be indicated in the case of an open fracture, severely displaced fracture, floating shoulder, neurovascular complications or polytrauma. Congenital pseudarthrosis requires operative treatment if the patient experiences progressive pain, functional limitation and late-onset thoracic outlet symptoms, but most operations are performed due to esthetic complaints.

Keywords: children; clavicle; diagnosis; fracture; pediatric; pseudarthrosis; treatment.

Figure 1

The Allman classification for clavicle fractures [13].

Figure 2

Left-sided pseudo-arthrosis (Type I) of the clavicle showing an elephant’s foot (A) and pencil point sign (B).

Figure 3

Congenital pseudo-arthrosis patient with an imminent protuberance on the left clavicle.

Figure 4

(a) Right clavicle fracture (Group I) with extreme displacement. (b) After 5 weeks of conservative treatment, early callus formation is visible.

Figure 5

(a) Segmental right clavicle fracture (Group I), with extreme displacement. (b) Surgical fixation using the plate-and-screw method.

Figure 6

(a) Right clavicle fracture (Group I) with extreme displacement. (b) Surgical fixation with an intramedullary wire.