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At least 91 records · Page 5Linked to original sources

PubMed1992

Osteolysis of the distal clavicle in a woman. Case report and review of the literature.

An unusual case of osteolysis of the distal clavicle in a woman is presented. Although almost 100 cases of osteolysis of the distal clavicle have been reported in the literature, none have occurred in females (Neer and Rockwood, 1984). After acute acromioclavicular dislocation, surgical reduction was carried out by transferring the coracoid process to the clavicle. Three years later the osteolysis of the outer clavicle appeared to be related to pain and functional impairment of the joint. The pain is quite tolerable and surgical excision of the distal clavicle has not yet been necessary.

Accidents, Traffic↗

PubMed1991

[Clavicle fracture in the newborn].

The authors have found 244 clavicle fractures during 4131 vaginal delivery (5.91%). Both clavicles of three newborns have fractured. The incidence of fracture had relation to weight of newborns, to weakness of pains and to vacuum extraction. The Apgar score of the newborns with fractured clavicle was not less, than one of newborns with unbroken clavicle. None of 704 newborns from cesarean section, and none of 52 newborns, who was born out of the hospital had fracture of the clavicle. The cause of fracture is the violent hurry of delivery, the drawing of the head before birth of shoulders. One of 244 injured newborns had permanent brachial plexus palsy. Late complication was not found. Between the injured newborns was more frequent the jaundice requiring phototherapy.

Apgar Score↗

PubMed1990

Clavicle fractures in the newborn.

A retrospective review of 21,632 live births from January 1982 to July 1987 was performed to determine the incidence and risk factors associated with fractures of the clavicle in the newborn. Fifty-eight fractures (57 patients) were identified, for an incidence of 2.7 clavicle fractures per 1000 live births. Fractures of the clavicle were associated with heavy neonates and shoulder dystocia. Three patients had concurrent clavicular fractures and Erb's palsy. These findings suggest that the incidence of clavicle fractures in the newborn may be reduced by identifying the macrosomic fetus and by minimizing shoulder dystocia. When clavicle fractures occur, a brachial plexus injury should be ruled out.

Apgar Score↗

PubMed1988

Anatomic and radiologic observations of the clavicle of adult dogs.

In an anatomic and radiologic study of the clavicle of 50 adult dogs of 10 breeds, the clavicle had ossified in 96% of the dogs. The clavicles studied had various shapes, and each clavicle was attached to the caudomedial part of the clavicular intersection of the brachiocephalic muscle, to the mastoid part of the cleidocephalic muscle, and to 4 radiating bands of connective tissue fasciculi. One band was attached to the caudal border of the scapula and fascia deep to the latissimus dorsi muscle, 1 was attached to the manubrium of the sternum, and 1 each was attached to the epimysia of the superficial pectoral and sternocephalic muscles. We concluded that, during movements of the thoracic limb, the clavicle and the 4 fasciculated connective tissue bands associated with it stabilize the position of the brachiocephalic muscle with relation to the crest of the greater tubercle of the humerus. Also, the fasciculated band attached to the caudal border of the scapula provides protection for nerves from the brachial plexus and axillary blood vessels that supply the thoracic limb.

Animals↗

PubMed1986

The role of movement and tissue interactions in the development and growth of bone and secondary cartilage in the clavicle of the embryonic chick.

There has been debate in the literature concerning whether the clavicle arises by intramembranous ossification, i.e. is a membrane bone, and whether secondary cartilage develops from its periosteal cells. A histological study of carefully staged embryos revealed that pre-clavicular mesenchyme undergoes condensation at H.H. stage 31-32, bone forms by H.H. stage 33 and that a transitory secondary cartilage appears late in H.H. stage 35, only to disappear by H.H. stage 36. Except for the transitory nature of the secondary cartilage, this histogenetic sequence is as seen in craniofacial membrane bones. Enzymic removal of the epithelium overlying clavicular mesenchyme from embryos of H.H. stages 26-34 and chorioallantoic grafting of the isolated mesenchyme, revealed an epithelial requirement for initiation of intramembranous ossification during H.H. stages 26-29, again similar to initiation of craniofacial osteogenesis. Secondary chondrogenesis was initiated neither in embryos paralysed with decamethonium iodide nor when clavicular mesenchyme (H.H. stages 29-33.5) was grafted to the chorioallantoic membranes of paralysed embryos, but did form in a small percentage (16-23%) of clavicles grafted to the membranes of mobile embryos. Failure of chondrogenesis in the former was attributed to a requirement for movement as a proximate chondrogenic stimulus and the low incidence of chondrogenesis in the latter to the stimulus provided by amniotic movements which persist in paralysed embryos. Secondary cartilage did form when clavicles were organ cultured, either submerged, or at the air-medium interface. This stands in contrast to craniofacial membrane bone such as the quadratojugal, which only forms secondary cartilage in vitro when cultured submerged. Growth of the clavicle was shown to increase 53-fold between 10 and 11 days of incubation, an increase which was diminished but not eliminated in paralysed embryos, and which correlated closely with the dramatic increase in embryonic movement which occurs between 10 and 11 days of incubation. Thus, the clavicle of the embryonic chick shares all of the features and epigenetic requirements of the craniofacial the embryonic chick shares all of the features and epigenetic requirements of of the craniofacial membrane bones, but is more dependent upon biomechanical factors for its growth.

Age Factors↗

PubMed1985

[The development of the clavicle in man].

The development of the human clavicle was studied in 50 to 60 d old human embryos. Our findings are summarized as follows: The whole clavicle develops from a cartilaginous anlage. In the middle part of the clavicle, an osseus cuff develops very early by the ossification in the perichondrium. In the lumen of this cuff, a cartilaginous cork persists which is resorbed and replaced by bone and marrow later than in other bones. It is possible that cartilaginous nests may persist in the middle part of the clavicle. In both extremities of the clavicle, the normal enchondral ossification exists as it is described in other anlages. It is difficult to explicate the syndrome of the cleido-facial and cleido-cranial dysostoses only as disturbances of the endesmal ossification.

Cartilage↗

PubMedDate not supplied

Condensing osteitis of the clavicle. Report of two cases and review of the literature.

Condensing osteitis of the clavicle, better defined as aseptic enlarging osteosclerosis of the clavicle, is a rare and benign idiopathic lesion. It is probably of degenerative or mechanical origin, and is most commonly seen in middle-aged women as a tender swelling over the medial one-third of the clavicle. Although the clinical features may be confusing and nonspecific, the typical radiographic and histopathological findings will mostly lead to a correct diagnosis of this disorder. The differential diagnosis is quite extensive. Most difficult to differentiate are: avascular necrosis of the medial clavicular epiphysis, sternoclavicular orsteoarthritis, low-grade chronic osteomyelitis, sternocostoclavicular hyperostosis and Tietze's syndrome. The authors recommend a thorough physical examination and technical tests, not only in subjects with pain of the clavicle but also in those with shoulder pain only, especially in women who are in their fourth decade. Treatment with analgesic and anti-inflammatory medications may be variably effective. In refractory cases excisions of the medial one-third of the clavicle may be indicated to offer better relief of symptoms as well as to exclude malignancy.

Adult↗

PubMed1997

Fossil clavicle of a middle Pleistocene hominid from the Central Narmada Valley, India.

The discovery of a Middle Pleistocene hominid clavicle is reported here. This discovery is particularly important because clavicles are hitherto unrepresented in the fossil record of Asia. The Narmada clavicle comes from the Boulder Conglomerate horizon at Hathnora near Hoshangabad in the Central Narmada Valley. This is the same deposit that previously yielded the Homo erectus/archaic Homo sapiens partial cranium, which has recently been dated to between 0.2 and 0.7 ma (million years ago). The specimen has some unusual morphology and is a very short and robust bone, far shorter than even the early African Homo erectus clavicles. It is about the size that would be expected in an adult human pygmy. This discovery reopens the debate on the taxonomic position of the Narmada hominid in human ancestry.

Animals↗

PubMed1991

The apical oblique view of the clavicle: its usefulness in neonatal and childhood trauma.

We analyzed clavicular radiographs of 26 patients with a history of trauma. The apical oblique projection of the clavicle was obtained with the injured side of the patient angled 45 degrees towards the X-ray tube and a 20 degrees cephalad angulation of the X-ray beam. This view proved to be more informative than the routine apical anteroposterior projection. It is especially effective in detecting nondisplaced fractures of the middle third of the clavicle in neonates and children. To verify our findings, we obtained apical anteroposterior and oblique radiographs of a specimen adult clavicle. On the oblique view with 20 degrees cephalad angulation of the X-ray beam, the measurements of the projected lengths of the anatomical specimen, especially those of the middle portion of the clavicle, were very close to the corresponding anatomical lengths.

Birth Injuries↗

PubMed1989

The arterial supply of the clavicle.

This report based on delineation of the arterial system with 3 component plastic material on 10 human cadavers describes the arterial supply to the clavicle. The study was performed in 2 parts. One part, which showed the total arterial supply to the clavicle and one part with selective injections of the relevant arteries, with the intention of finding a central nutrient arterial supply to the clavicle. Three arteries were found to supply the clavicle: the suprascapular a.; the thoracoacromial a.; and the internal thoracic (mammary) a. The main supply was primarily periosteal. No nutrient artery was found.

Aged↗

PubMed2000

[Post-traumatic osteolysis of the distal clavicle. A case report and review of the literature]].

The post-traumatic osteolysis of the distal clavicle is very infrequent and the etiology and pathology is poorly understood. It is important to consider this possibility for differential diagnosis when continued pain in the acromio-clavicular joint (AC joint) follows blunt shoulder trauma. The course of the disease may result in a 3 cm loss of length of the distal clavicle. Months and years may pass until osteolysis becomes manifest, but the earliest radiological findings are present 4 weeks after trauma. The disease is self-limiting and usually does not leave residues. We report a case of a 35-year-old man with a post-traumatic osteolysis of the distal clavicle after blunt shoulder trauma. The diagnosis was determined several months after pain persisted in his shoulder. Using this case we discuss the possible pathogenic mechanism, differential diagnosis and treatment options for the post-traumatic osteolysis of the distal clavicle.

Adult↗

PubMed2006

Tension band suturing for the treatment of displaced type 2 lateral end clavicle fractures.

INTRODUCTION: Non-operative treatment of Neer type 2 lateral end clavicle fractures presents a difficult problem due to the high incidence of non-union, delayed union and resulting shoulder girdle instability. Operative techniques described may require extensive soft tissue reconstruction, implant removal or lead to implant failure. MATERIALS AND METHODS: We report a modified tension band suturing technique for the treatment of these lateral end displaced clavicle fractures that avoids these problems of extensive soft tissue dissection, implant removal or implant failure. Ten patients were reviewed clinically, radiologically and with Constant assessment score outcomes using the tension band suture for the treatment of these fractures. RESULTS: All the fractures had healed at a mean follow-up of 9.2 weeks (range 6-16 weeks) with a mean Constant score of 91 and the power was comparable to the normal shoulder using the Nottingham Myometer. CONCLUSION: The results of this pilot study for treatment of Neer's type 2 lateral end clavicle fractures are very encouraging. We do recommend the need for a prospective larger study of this technique for the treatment of Neer type 2 lateral end clavicle fracture to evaluate this technique further.

Adolescent↗

PubMed2001

Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion.

Up to 15% of all fractures involve the clavicle. Nonunion of the clavicle is a rare complication after conservative treatment. It mainly presents as pain at the fracture site and a limited range of motion of the shoulder. The purpose of this study is to define a certain type of fracture of the clavicle that is predisposed to malunion and therefore should be treated surgically after failure of conservative treatment. Thirty-nine patients with delayed or malunion of the clavicle were analyzed. There were 13 women and 26 men. The average age of the male patients was 36.4 years (range 20-59 years) and of the female patients, 43.6 years (range 18-55 years). The mean follow-up period was 2.3 years (range 6 months to 4.2 years). All of them were treated surgically. There were 33 Allman I fractures and 6 Allman II fractures. Of the Allman I fractures, 30 (91%) were shortened by at least 2 cm. Allman I fractures were treated using a reconstruction plate or a dynamic compression plate in combination with bone grafting. The time of operation after fracture ranged from 6 weeks to 8.5 years (average 9.8 months). Pain at the fracture site was the leading symptom in all patients. At 6 months after the operation, 38 patients were free of pain with an unlimited range of motion of the shoulder. One patient (2.6%) complained of a slight weakness on the operated site. One fracture failed to unite (2.6%) and had to be replated. There were no refractures, infections, vessel or nerve lesions. To conclude, in Allman I fractures with a shortening of more than 2 cm, we recommend operative treatment in symptomatic patients if there are no signs of callus formation after 6 weeks.

Adolescent↗

PubMed1994

Low-contact dynamic compression plating of the clavicle.

Internal fixation of the clavicle is rarely necessary. When it is warranted, the clavicle's complex three-dimensional morphology and functional anatomy, proximity to vital structures, and the multidirectional biomechanical forces acting upon it place considerable demands on any implant used for skeletal fixation. We treated nine clavicles with the recently-introduced 3.5 mm low contact-dynamic compression plate (LC-DCP). Surgery was performed for symptomatic non-union in six patients, shoulder dysfunction following a malunited fracture in one, for an open fracture in one, and for an acute fracture associated with brachial plexus injury in one. After an average follow-up period of 17 months union was secured in each case. The advantages afforded by the 3.5 mm LC-DCP in internal fixation of the clavicle with its uniquely demanding anatomical and biomechanical characteristics are discussed.

Adolescent↗

PubMedDate not supplied

Ligamentous anatomy of the distal clavicle.

We describe the insertional variations of supporting ligaments of the acromioclavicular joint, especially with respect to gender. We analyzed 41 cadaveric clavicles (22 female and 19 male) with attached ligaments. The distance between the insertion of the trapezoid ligament and the distal end of the clavicle was not significantly different between sexes, although that of the conoid ligament and the mean anteroposterior width of the distal clavicle was significantly greater in men. Although there are significant sex-related differences in the insertional distances of the CC ligaments, resection of less than 11.0 mm should not violate the trapezoid ligament and less than 24.0 mm should not violate the conoid ligament in either sex in 98% of the general population. Resection of more than 7.6 mm of the distal clavicle in men and 5.2 mm in women, performed by an arthroscopic approach, may violate the superior acromioclavicular ligament.

Aged↗

PubMed2000

Osteolysis of the distal clavicle: long-term results of arthroscopic resection.

PURPOSE: The purpose of this study was to evaluate the outcome of arthroscopic distal clavicle resection by the direct superior approach for treatment of isolated osteolysis of the distal clavicle. TYPE OF STUDY: Case series. MATERIALS AND METHODS: Forty-one shoulders in 37 patients underwent arthroscopic resection of the distal clavicle. Thirty-three patients were male and 4 female, with an average age of 39 years. All patients complained of pain localized to the acromioclavicular joint region. Symptoms began after a traumatic event in 18 shoulders and were associated with repetitive stressful activity in 23 shoulders. RESULTS: At an average follow-up of 6.2 years, 22 shoulders had excellent results, 16 had good results, and 3 were failures. All 3 failures occurred in patients with a traumatic etiology. CONCLUSIONS: Arthroscopic resection for osteolysis of the distal clavicle has results comparable to open excision with low morbidity. Patients with a traumatic etiology had slightly worse results compared with patients with a microtraumatic etiology.

Adult↗

PubMedDate not supplied

Reossification and fusion across the acromioclavicular joint after arthroscopic acromioplasty and distal clavicle resection.

Arthroscopic acromioplasty and distal clavicle resection has now become an accepted method of treatment for acromioclavicular (AC) joint arthritis. Complications following arthroscopic acromioplasty are relatively uncommon and include instrument breakage, hematoma, traction neuropathy, infection, acromial fracture, reflex sympathetic dystrophy, and recurrence of symptoms. Although heterotopic ossification within the soft tissues has also been reported, complete reossification of the resected clavicle has not. We report a case of reossification of the clavicle and fusion across the AC joint following arthroscopic acromioplasty and distal clavicle resection.

Acromioclavicular Joint↗

PubMed2005

Surgical treatment of congenital pseudarthrosis of the clavicle: a report of three cases and review of the literature.

Congenital pseudarthrosis of the clavicle is a rare entity of unknown aetiology with predominance of the right side. Our therapeutic concept is discussed with special reference to surgical therapy, histopathological findings and the most recent literature. Two girls and one boy, aged 4, 6, and 8 years, presenting with congenital pseudarthrosis of the clavicle were surgically treated between 1994 and 2000. A resection of the pseudarthrosis and internal fixation with a small reconstruction plate was performed. A bone graft from the iliac crest was used for restoration of clavicular length. Histological examination revealed a false joint with the ends of the clavicle covered by hyaline cartilage. The patients showed radiographic healing after 12 weeks. At follow-up (mean 44 months), all patients showed excellent clinical and radiological results without functional impairment. The clinical features and histological examination of the resected pseudarthroses clearly proved the diagnosis of a true congenital pseudarthrosis of the clavicle. According to our clinical and radiological results and considering the recent literature, we recommend surgical therapy with resection, bone grafting, and osteosynthesis with a reconstruction plate around the age of 4 - 6 years.

Bone Transplantation↗