CLAVICLE PSEUDOARTHROSIS
When describing pseudoarthrosis of the clavicle, a doctor will tell you that the outer portion of the collarbone (the end that rests on the shoulder blade) is separated from the central portion (the end that rests on the breastbone).
If your child needs surgery or casting, our Fracture Care Clinic opens every day and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.
Clavicle Pseudoarthrosis
Clavicle pseudoarthrosis is a condition where the clavicle (also known as the collarbone) fails to heal properly after a fracture. So, instead of healing the bone forms a false joint or “pseudo-joint.” Also, this means that the bone does not fuse together and can move abnormally. Pseudoarthrosis of the clavicle is a rare complication that occurs in about 1-2% of clavicle fractures. It is more common in certain populations, such as those with osteoporosis. In addition, smokers, or individuals who have had previous surgery on the clavicle are seen with this condition.
The symptoms of clavicle pseudoarthrosis can vary but often include pain, swelling, and instability of the shoulder. In some cases, the clavicle may protrude through the skin, causing an open wound. Furthermore, treatment for clavicle pseudoarthrosis typically involves surgery. The surgeon will remove any non-union tissue and stabilize the bone with plates, screws, or wires. Rehabilitation and physical therapy may also be necessary to help regain strength and mobility in the affected area.
Overall, clavicle pseudoarthrosis can be a challenging condition to treat. However, with proper management, most people can achieve good outcomes and return to normal activities.
Causes of Clavicle Pseudoarthrosis
Clavicle pseudoarthrosis is caused by a failure of the clavicle to heal properly after a fracture. There are several factors that can contribute to the development of this condition, including:
- Inadequate blood supply: The clavicle has a relatively poor blood supply. This can make it difficult for the bone to heal properly after a fracture.
- Poor alignment: If the broken ends of the clavicle are not properly aligned, healing can be difficult.
- Infection: In some cases, an infection at the site of the fracture can interfere with the healing process. This will lead to the development of pseudoarthrosis.
- Smoking: Smoking can interfere with the body’s natural healing processes. Smoking will also increase the risk of developing pseudoarthrosis.
- Osteoporosis: People with osteoporosis have weaker bones, which can make it more difficult to heal.
- Previous surgery: If an individual has had previous surgery on the clavicle, it can increase the risk of developing a pseudoarthrosis.
Overall, the exact cause of clavicle pseudoarthrosis can be complex and multifactorial and may involve a combination of factors.
QUESTIONS AND ANSWERS
What causes Clavicle Pseudoarthrosis?
Clavicle pseudoarthrosis typically occurs when a previous clavicle fracture fails to heal properly. Several factors can contribute to this, including inadequate immobilization or stabilization of the fracture, infection at the fracture site, poor blood supply to the area, or underlying medical conditions that impede the body’s ability to heal bone. Patients with a history of clavicle fractures should follow their healthcare provider’s recommendations for treatment and rehabilitation to reduce the risk of pseudoarthrosis.
How do doctors diagnose Clavicle Pseudoarthrosis?
The diagnosis of clavicle pseudoarthrosis typically involves a combination of clinical evaluation and imaging studies. A healthcare provider will assess the patient’s medical history, symptoms, and physical examination findings. Doctors will use X-rays, CT scans, or MRI scans to confirm the presence of pseudoarthrosis by revealing a persistent gap or lack of bone union at the fracture site. Accurate diagnosis is essential as it guides treatment decisions.
What are the treatment options for Clavicle Pseudoarthrosis?
- Answer: The treatment of clavicle pseudoarthrosis often requires surgical intervention. The specific surgical approach may vary depending on the individual case, but common techniques include:
- Bone grafting: Surgeons may use bone grafts from the patient’s own body (autograft) or from a donor (allograft) to fill the gap at the non-union site and stimulate bone healing.
- Internal fixation: Surgeons will use hardware such as plates, screws, or rods to stabilize the clavicle and promote proper bone union.
- Electrical stimulation: In some cases, doctors will use electrical stimulation to encourage bone growth at the non-union site.
Doctors may recommend post-surgery, rehabilitation, and physical therapy to help the patient regain strength and function in the affected shoulder and collarbone. The choice of treatment will depend on factors such as the patient’s age, overall health, the location and size of the pseudoarthrosis, and the surgeon’s expertise. It is crucial to consult with a qualified orthopedic specialist for a personalized evaluation and treatment plan.
Whether minor or major health issue, the doctors at Medical City Children’s Orthopedics and Spine Specialists have the expertise and experience to treat your child with excellence.
Symptoms of Clavicle Pseudoarthrosis
The symptoms of clavicle pseudoarthrosis can vary depending on the severity of the condition. Some people may have no symptoms at all, yet others may experience significant pain and disability. Common symptoms of clavicle pseudoarthrosis include:
- Pain: Pain around the site of the fracture is a common symptom of clavicle pseudoarthrosis. The pain may be constant or intermittent and may be worse with movement.
- Swelling: Swelling around the site of the fracture may occur due to inflammation or fluid accumulation.
- Instability: Pseudoarthrosis can cause instability in the shoulder, making it difficult to move the arm or lift objects.
- Limited range of motion: Pseudoarthrosis can limit the range of motion in the affected shoulder, making it difficult to perform certain activities.
- Visible deformity: In some cases, the clavicle may protrude through the skin, causing an open wound or visible deformity.
- Muscle weakness: Pseudoarthrosis can cause muscle weakness and atrophy in the affected arm.
- Numbness or tingling: Pseudoarthrosis can compress nerves in the area, leading to numbness or tingling in the arm or hand.
It is important to note that not all clavicle fractures will result in pseudoarthrosis. In addition, not all cases of pseudoarthrosis will have noticeable symptoms. If you have any concerns about a clavicle fracture or pseudoarthrosis, it is important to consult with a healthcare provider.
Diagnosing Clavicle Pseudoarthrosis
Diagnosis of clavicle pseudoarthrosis typically involves a combination of medical history, physical examination, and imaging tests. Here are some of the ways a doctor may diagnose clavicle pseudoarthrosis:
- Medical history: The doctor will ask about your child’s symptoms and any previous injuries. In addition, the doctor will gather medical conditions that may be contributing to your child’s current symptoms.
- Physical examination: The doctor will examine the affected area, looking for signs of swelling, instability, deformity, or other abnormalities.
- X-rays: X-rays are often the first imaging test ordered to evaluate the clavicle fracture and to look for signs of pseudoarthrosis.
- CT scan: A CT scan may be ordered if the X-rays are inconclusive or if the doctor needs more detailed images of the affected area.
- MRI: An MRI may be ordered if the doctor suspects nerve or soft tissue damage in the affected area.
- Bone scan: A bone scan may be ordered to evaluate bone density and to look for any signs of infection or inflammation in the affected area.
Once a diagnosis of clavicle pseudoarthrosis is made, the doctor will work with you to develop an appropriate treatment plan. Treatment may involve surgery to remove any non-union tissue and to stabilize the bone. the surgeon will use plates, screws, or wires to stabilize the bones. Rehabilitation and physical therapy may also be necessary to help regain strength and mobility in the affected area.
Treating Clavicle Pseudoarthrosis
The treatment of clavicle pseudoarthrosis typically involves surgery that removes the non-union issue. The surgeon will fix damaged tissue and stabilize the bone with plates, screws, or wires. The specific surgical technique used will depend on the location and severity of the pseudoarthrosis. The surgeon will take into consideration other individual factors such as age and overall health.
Here are some of the surgical options for treating clavicle pseudoarthrosis:
- Bone grafting: This involves taking a piece of bone from another part of the body, such as the hip or leg, and using it to fill in the gap between the non-healing bone ends. The bone graft helps to stimulate new bone growth and promote healing.
- Internal fixation: This involves the use of plates, screws, or wires to stabilize the bone and hold it in the correct position. This allows the bone to heal properly and helps to prevent future instability.
- External fixation: This involves the use of an external device, such as a brace or cast, to hold the bone in place and promote healing. This may be used in conjunction with other surgical techniques or on its own.
- Revision surgery: In some cases, revision surgery may be necessary if the initial surgery did not result in complete healing or if there are complications such as infection or nerve damage.
In addition to surgery, rehabilitation, and physical therapy may also be necessary to help regain strength and mobility in the affected area. The length of rehabilitation and recovery time will vary depending on the severity of the pseudoarthrosis and the specific surgical techniques used.
Recovering from Clavicle Pseudoarthrosis
The recovery time for clavicle pseudoarthrosis can vary depending on the severity of the condition. This also includes the type of surgery performed and individual factors such as age and overall health. In general, recovery from surgery for clavicle pseudoarthrosis can take several months. During the first few weeks after surgery, your child may need to wear a sling or brace. The sling or brace will protect the affected area and allow the bone to heal. Your child may also need to avoid certain activities, such as heavy lifting or overhead movements, to prevent further injury and promote healing.
Finally, after a few weeks, your child may begin physical therapy to help improve the range of motion, strength, and flexibility in the affected area. The length of physical therapy will vary depending on the severity of the pseudoarthrosis and the individual’s progress in rehabilitation. Overall, it can take several months to fully recover from clavicle pseudoarthrosis. Your doctor will provide specific instructions and guidelines for postoperative care and rehabilitation to help optimize your child’s recovery and ensure the best possible outcome.
We invite new patients at our Medical City Children’s Orthopedics and Spine Specialists practice. We have offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX and treat children who have broken clavicles or collar bones.
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Footnote:
JAMA: Congenital Pseudarthrosis of the Clavicle
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