Congenital Psudoarthrosis of clavicle
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Transcript of Congenital Psudoarthrosis of clavicle
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WELCOME TO
DAILY TOPIC PRESENTATION
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Dr. Maftun Ahmed Resident NITOR
Congenital Psudoarthrosis Of
Clavicle
Daily Topic On CPC
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Daily Topic On CPC
Introduction:
• Congenital pseudarthrosis of the clavicle (CPC) is a rare condition of unknown etiopathogenesis, not associated with any H/O birth injury.
• First reported by Fitzwilliams in 1910, since then about 200 cases have been reported in literature in last hundred years.
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Daily Topic On CPC
Introduction: (cont)
• usually unilateral.• Right side is mostly affected.• Left sided unilateral lesions: associated with
Dextrocardia.• During childhood, function is unaffected and
less symptoms • A relative female predominance (70%) was
also observed.
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Daily Topic On CPC
Etiology:
• Two major theories are• Intrinsic failure of devolopment related to the
embryogenesis of the clavicle (Fawcett 1913)
• Extrinsic pressure on Clavicle :Most authors believe that the lesion is caused by pressure exerted upon the developing clavicle by the pulsating subclavian artery.
• Unknown
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Daily Topic On CPC
Etiology: (cont.)
Intrinsic:• 2 primary ossification centres are
formed, one medial and the other lateral, in the 5th and 6th gestational weeks and fuse during 7th week of fetal development,
• Interrupted formation of the two primary ossification centres and failure of these to coalesce at 7th week could be responsible for clavicular pseudarthrosis.
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Daily Topic On CPC
Extrinsic:• Lloyd-Roberts observed that Right
sided predominance may be result of higher Subclavian artery on right side
• This causing extrinsic pressure on the budding clavicle by the adjacent pulsatile subclavian artery during fetal devolopment.
• Others: Cervical ribs
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Daily Topic On CPC
Clinical Features:
• Painless prominence in the middle of the clavicle at birth or in early neonatal life.
• End of the clavicular segments are enlarged at the site of the pseudarthrosis and there is some degree of motion between them.
• The skin above the prominence may become atrophic
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Daily Topic On CPC
Radiographic Features:
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Daily Topic On CPC
Differential Diagnosis:
• Cleidocranial dysostosis: which is characterised by hypoplasia / aplasia of the
lateral clavicular ends, retarded cranial ossification, supernumerary teeth and short stature.
• Dissimilar location (lateral involvement), tapering of both bone ends and co-existing structural abnormalities distinguish itself from congenital pseudarthrosis of Clavicle.
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Daily Topic On CPC
Differentials: cont.
• Post-traumatic pseudarthrosis: Usually a history of trauma or birth injury, Always painful and tender on pressure with motion
between fragments. The radiograph shows exuberant callus formation.
• Neurofibromatosis. There are no cafe au lait spots Ends of the segmems are seen to be enlarged (bulbous) in cases of congenital pseudarthrosis whereas
in cases of neurofibromatosis they are tapered.
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Daily Topic On CPC
Treatment:• In most series the preferred treatment has been
surgery.• Undertaken either at the parents' request or in order
to strengthen the shoulder or remove the lump.
• Surgery should be delayed until the patient is at least of preschool age.
• Excision of the pseudarthrosis combined with cancellocortical onlay grafts is favoured.
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Daily Topic On CPC
Treatment: (cont.)
• Using an External fixator is another possible technique.
• Since aesthetics are the major concern, the surgery is performed during childhood with an external fixator, yielding better cosmetic results with smaller postoperative scars
• avoiding the need for a second surgical procedure to remove the implants.
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Daily Topic On CPC
References:
• Lovell & Winter’s Paediatric Orthopaedics, 4th Edition,
• Sharrard’s Paediatric Orthopedics and Fracture, Vol.1, 2nd Edition
• Internet.
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Daily Topic On CPC
THANK YOU