Comparison of two methods in the treatment of congenital pseudarthrosis of clavicle: multicenter experience

Jin Li,Xin Tang,Hai Bo Mei,Hai Qiang Wang,Bao Jie Shi,Jing Fan Shao,Sheng Ping Tang

doi:10.1186/s13018-021-02438-x

Abstract

BackgroundCongenital pseudoarthrosis of the clavicle (CPC) is an uncommon entity. Owing to its scarce presentation, treatment of this disorder has not been well established. This study aimed (1) to compare surgical treatment methods that included excision of pseudoarthrosis and iliac crest bone graft and fixate with either the elastic stable intramedullary nail (ESIN) or K-wires or plate and screws, and (2) to assess the clinical outcomes of two different surgical methods.MethodsA multi-central retrospective study was performed between 2013 and 2017 in four tertiary teaching hospitals. Fifteen clavicles of 11 children were identified as CPC. All patients underwent pseudarthrosis resection and iliac crest bone autograft. They were divided into two groups as per the surgical treatment they underwent—plate stabilization as group A and elastic stable intramedullary nailing (ESIN) or K-wires as group B. Nine clavicles in 6 patients in group A and 6 clavicles in 5 patients in group B, were included. The Quick Disabilities of the Arm and Shoulder (QuickDASH) score was used to assess patients’ satisfaction and function following treatment at each follow-up.ResultsThere were eight boys and three girls, with an average age of 4.7 years. All patients, except one with intellectual impairments, had radiological healing. Implant removal time was significantly shorter in group B compared to group A. No statistically significant differences existed in terms of age at surgery, time of radiological healing, complication, and clinical outcome between different groups.ConclusionSurgical resection of pseudoarthrosis with an iliac crest bone graft was an effective means of surgical treatment in CPC. However, ESIN or K-wires can achieve shorter union time compared to the plate. Hence, surgical treatment is recommended for congenital pseudarthrosis of clavicular in pediatric patients.Level of evidenceRetrospective comparative study; Level III

Highlights

Congenital pseudarthrosis of clavicular (CPC) is a rare disease, which was first reported in 1910 by Fitzwilliams
Patients were divided into two groups as per the surgical treatment they underwent—plate stabilization as group A and elastic stable intramedullary nailing (ESIN) or Kirschner wires (K-wires) as group B
All patients had a painless lump without other subjective anomalies or disfunction, and all of them underwent the same surgical procedure using either ESIN or K-wires or plates and screws

Summary

Introduction

Congenital pseudarthrosis of clavicular (CPC) is a rare disease, which was first reported in 1910 by Fitzwilliams. It has a predilection for the right clavicle in girls [1, 2], seldom occurred in the left side. The etiology of CPC remains unclear; it is believed to be associated with the failure to fuse ossification centers of clavicle during the embryogenetic stage [5]. Another plausible hypothesis is related to the subclavian artery on the developing clavicle, which situates at a higher position than the normal during intrauterine life [3, 6]. This study aimed (1) to compare surgical treatment methods that included excision of pseudoarthrosis and iliac crest bone graft and fixate with either the elastic stable intramedullary nail (ESIN) or K-wires or plate and screws, and (2) to assess the clinical outcomes of two different surgical methods

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