Surgical treatment of congenital pseudarthrosis of the clavicle: a series of 10 cases.

INTRODUCTION: Congenital pseudarthrosis of the clavicle (CPC) is a rare congenital malformation. We describe the outcomes of surgical treatment of CPC in a series of 10 patients. The hypothesis was that surgical treatment is an acceptable solution that will lead to satisfactory healing in asymptomatic patients. The aims were to determine if 1) surgical treatment of CPC will produce a satisfactory union rate, 2) surgical treatment causes complications and impacts the postoperative outcomes and 3) risk factors can be identified that affect the success of the surgical care.

METHODS: Ten patients with CPC who were treated by resection and bone grafting were included in this case series. The CPC was always in the right clavicle. All patients except one were asymptomatic preoperatively. The mean age at the time of the procedure was 5.1 years (range, 1.7-13.4). The initial fixation consisted of a K-wire in 9 patients and a plate in 1 patient. Iliac crest autograft was harvested in all patients. The mean length of postoperative immobilization was 10 weeks (range, 6-18 weeks).

RESULTS: At a mean follow-up of 29 months (range, 3-129 months), all patients were pain-free and had full range of motion. Bone union was achieved in 70% (7/10) after revision at a mean of 3.8 months (range, 1.1-13.3). Three clavicles did not heal, two of which had been revised surgically. Four patients suffered a complication: three cases of K-wire migration and one case of infection. Among them, two patients had the fixation changed to a plate while preserving the graft, while the fixation device was removed in two patients, one of whom was undergoing revision for infection. The patients who had complications were all under 5 years of age at the time of surgery (mean 3.7 years, range 1.7-5 years).

CONCLUSION: Surgical treatment of CPC generates a moderate union rate with a complication risk that is not insignificant. Age at the time of surgery appears to affect the outcomes. Thus, we propose waiting until the patient is at least 5 years of age before implementing surgical treatment.

LEVEL OF EVIDENCE: IV, Retrospective study.