Surgical treatment of congenital pseudoarthrosis of the clavicle in children

Cover Page

Cite item

Full Text

Abstract

Introduction. In the literature the issue of indications for surgical treatment of CPC (congenital pseudoarthrosis of the clavicle) is exposed to discussion. Also, there are no accurate age indications for surgery. The conducted research has shown that the course of CPC is accompanied by clavicle shortening as well as by bone fragments deformation in 60% of the cases, which has a significant effect on the planning of surgery.

Purpose of study: to develop a differentiated approach to the treatment of congenital pseudoarthrosis of the clavicle in children, taking into account the clinical and radiological picture.

Patients and methods. 27 patients with the congenital pseudoarthrosis of the clavicle (CPC) aged from 4 up to 16 years old were operated. In 6 observations bone fragments deformation of the clavicle was absent, and in 21 observations various deformations occurred. The surgery included restoration of clavicle axis, replacement of bone tissue defect with bone autograft, fixation of bone fragments with a needle.

Results. After the first surgery, bone fragments consolidation of the false joint was reached in 82% of the cases (22 patients); the recurrence of the false joint was observed in 18% (5 patients). Repeated surgeries were successfully performed on four of them; one patient is being observed on an outpatient basis.

Conclusion. The results of the surgical treatment have shown that for the union of a false joint it is necessary to use differentiated approach to the adoption of surgical technique with regard to bone fragments deformation. Partially eliminated deformation and clavicle sternal bone fragment high standing served as the main reason for the recurrence of pseudoarthrosis.

About the authors

A. P. Pozdeev

Federal State Budgetary Institution The Turner Scientific Research Institute for Children’s Orthopedics

Email: prof.pozdeev@mail.ru
ORCID iD: 0000-0001-5665-6111

MD, PhD, Professor, Chief Researcher of the Department of Bone Pathology, Scientific Research Institute for Children’s Orthopedics

Russian Federation, Saint-Petersburg

E. A. Belousova

Federal State Budgetary Institution The Turner Scientific Research Institute for Children’s Orthopedics

Email: qeenl8@mail.ru

traumatologist-orthopedist, senior laboratory assistant of the Department of Pediatric Traumatology and Orthopedics

Russian Federation, Saint-Petersburg

O. N. Sosnenko

Federal State Budgetary Institution The Turner Scientific Research Institute for Children’s Orthopedics

Author for correspondence.
Email: sosnenko.olga@yandex.ru

MD, PhD, Manager of the Department of Bone Pathology

Russian Federation, Saint-Petersburg

References

  1. Fitzwilliams D. Hereditary cranio-cleido-dysostosis. Lancet. 1910;2:1466. https://doi.org/10.1016/s0140- 6736(01)38817-7.
  2. Поздеев А.П., Сухарская Ю.Б. Врожденный ложный сустав ключицы. Клинико-рентгенологическое исследование. Ортопедия, травматология и восстановительная хирургия детского возраста. 2016;4(1):43-8. [Pozdeev А.Р., Suharskaja Ju.В. Vrozhdennyj lozhnyj sustav kljuchicy. Kliniko-rentgenologicheskoe issledovanie. Ortopedija, travmatologija i vosstanovitel’naja hirurgija detskogo vozrasta. 2016;4( 1 ):43-8. (In Russ.)], https://doi.org/10.1016/ s0140-6736(01)38817-7.
  3. Owen R. Congenital pseudarthrosis of the clavicle. J Bone Joint Surg Br. 1970;52(4):644-52.
  4. Ahmadi B., Steel H.H. Congenital pseudarthrosis of the clavicle. Clin Orthop Relat Res. 1977;126:129-34. https:// doi.org/10.1097/00003086-197707000-00020.
  5. Lloyd-Roberts G.C., Apley A.G., Owen R. Reflections upon the aetiology of congenital pseudarthrosis of the clavicle. With a note on cranio-cleido dysostosis. J Bone Joint Surg Br. 1975;57(l):24-9.
  6. Rabenseifner L. Etiology and therapy of clavicular-pseudarthrosis. Aktuelle Traumatol. 1981;11(4): 130-2.
  7. Lorente Molto F.J., Bonete Lluch D.J., Garrido I.M. Congenital pseudarthrosis of the clavicle: a proposal for early surgical treatment. J Pediatr Orthop. 2001;21 (5):689-93. https://doi.org/10.1097/01241398-200109000-00026.
  8. Persiani P., Molayem I., Villani C. et al. Surgical treatment of congenital pseudarthrosis of the clavicle: a report on 17 cases. Acta Orthop Belg. 2008;74(2):161-6.
  9. Herring J.A. Pseudarthrosis of the clavicle. Tachdjian’s pediatrics orthopaedics. 4th ed.: Philadelphia: WB Saunders; 2008.
  10. Studer K., Baker M.P., Krieg A.H. Operative treatment of congenital pseudarthrosis of the clavicle: a single-centre experience. J Pediatr Orthop. 2017;26(3):245-9. https:// doi.org/10.1097/BPB.0000000000000400.
  11. Di Gennaro G.L., Cravino M., Martinelli A. et al. Congenital pseudarthrosis of the clavicle: a report on 27 cases. J Shoulder Elbow Surg. 2017;26(3):e65-e70. https://doi. org/10.1016/j.jse.2016.09.020.
  12. Sloan A., Paton R. Congenital pseudarthrosis of the clavicle: the role of CT-scanning. Acta Orthop Belg. 2006;72(3):356- 8.
  13. Ahmadi B., Steel H.H. Congenital pseudarthrosis of the clavicle. Clin Orthop Relat Res. 1977; 126:129-34. https:// doi.org/10.1097/00003086-197707000-00020.
  14. Lloyd-Roberts G.C., Fixsen J.A. Congenital pseudarthrosis of the clavicle. In: Canale S.T., ed. Orthopaedics in infancy and childhood. London: Butterworth-Heinemann; 1989.
  15. Gibson D.A., Carroll N. Congenital pseudarthrosis of the clavicle. J Bone Joint Surg Br. 1970;2013:629-43.
  16. Al-Hadidy A., Haroun A., Al-Ryalat N. et al. Congenital pseudarthrosis associated with venous malformation. Skeletal Radiol. 2007;2013:15-8. https://doi.org/10.1007/ S00256-006-0175-4.
  17. Beslikas T.A., Dadoukis D.J., Gigis I.P. et al. Congenital pseudarthrosis of the clavicle: a case report. J Orthop Surg (Hong Kong). 2007;2013:87-90. https://doi. org/10.1177/230949900701500120.
  18. Russo M.T., Maffulli N. Bilateral congenital pseudarthrosis of the clavicle. Arch. Orthop. Trauma Surg. 1990; 109(3): 177- 8. https://doi.org/10.1007/bf00440584.
  19. Веселовский Ю.А. Ложные суставы ключицы у детей и подростков и их лечение. Ортопедия, травматология и протезирование. 1980;10:44-5. [Veselovsky Yu.A. Lozhnyjе sustavy klyuchitsy u detej i podrostkov i ikh lechenie. Ortopedija, travmatologija i protezirovanie. 1980;10:44-5. (In Russ.)].
  20. Корж A.A., Шевченко С.Д., Филиппенко В.А. Лечение врожденного псевдоартроза ключицы. Ортопедия, травматология и протезирование. 1983;4:22-4. [Korzh А.А., Shevchenko S.D., Filippenko V.A. Lechenie vrozhdennogo psevdoartroza klyuchitsy. Ortopedija, travmatologija i protezirovanie. 1983;4:22-4. (In Russ.)].
  21. Price C.T., Phillips J.H., Devito D.P. Pseudartrosecongenita da clavicula. In: Morrissy R.T., Weinstein S.L., eds. Ortopediapediatrica de Lovelle Winter. Philadelphia: Lippincott Wiliams&Wilkins; 2005.
  22. Cadilhac C., Fenoll B., Peretti A. et al. Congenital pseudarthrosis of the clavicle: 25 childhood cases. Rev Chir Orthop Reparatrice Appar Mot. 2000;86(6):575-80.
  23. Salati S.A. Congenital pseudarthrosis of the clavicle. East Cent Afr J Surg (online). 2012; 17( 1): 111.
  24. Chandran P., George H., James L.A. Congenital clavicular pseudarthrosis: comparison of two treatment methods. J Child Orthop. 2011;5(1): 1-4. https://doi.org/10.1007/ sl 1832-010-0313-3.
  25. Toledo L.C., MacEwen G.D. Severe complication of surgical treatment of congenital pseudarthrosis of the clavicle. Clin Orthop Relat Res. 1979;139:64-7. https://doi. org/10.1097/00003086-197903000-00009.
  26. Shim J.S., Chang M.J. Congenital pseudarthrosis of the clavicle — report of 4 cases treated with surgical methods. J Korean Orthop Assoc. 2008;43:396-9. https://doi. org/10.4055/jkoa.2008.43.3.396.
  27. Поздеев А.П. Ложные суставы и дефекты костей у детей (этиология, клиника, лечение): Дис.... д-ра мед. наук. СПб; 1998. [Pozdeev А.Р. Pseudarthroses and bone defects in children (etiology, clinical picture, treatment). Dr. med. sci. Diss. St. Petersburg; 1998. (In Russ.)].

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Scheme of operation at VLSK without deformation of fragments. 1 — false joint area; 2 — «H»-shaped autograft; 3 — intramedullary fixation with a spoke.

Download (1MB)
Indexing metadata
3. Fig. 2. Congenital pseudoarthrosis of the clavicle with deformity of the acromial fragment. a — acromial end of the clavicle with marked vertex deformation; b — the scheme of the operation: 1 — the region of the corticothomy fragment; 2 — «H»-shaped autograft; 3 — locking intramedullary needle.

Download (1MB)
Indexing metadata
4. Fig. 3. VLSK with deformation of the sternal fragment. Scheme of operation: 3.1 — vertex deformation; 3.2 — area corticotomy fragment; 3.3 — «H»-shaped autotranplantat; 3.4 — intramedullary fixation rod.

Download (1MB)
Indexing metadata
5. Fig. 4. Surgical treatment of a patient with deformation of both their clavicle fragments. a —computed tomography of congenital false joint clavicle with deformity of both fragments: 4.1 — tops deformation of bone fragments clavicle; b — VLCC dethe formation of the acromial and sternal fragments. Scheme operation: 4.2 — vertex deformation; 4.3 — area Cortiof kotomi fragment; 4.4 — «H»-shaped autograft; 4.5 — intramedullary fixation with a spoke.

Download (1MB)
Indexing metadata
6. Fig. 5. Patient I. Clinical observation. Radiograph and CT scan before treatment (5.1 — vertex deformationfunctions of fragments of the clavicle); b — x-ray intraopration; in the radiograph 1 year after surgery.

Download (4MB)
Indexing metadata

Copyright (c) 2019 Eco-Vector



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies