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John T. Killian, MD, Orthopaedic
Specialists of Alabama, Pediatric Orthopaedics, Birmingham,
AL
Eight patients with symptomatic
congenital pseudoarthritis of the right clavicle were treated
with surgical reconstruction. The age at presentation ranged
from one month of age to twelve years of age; six of the eight
were males. Five of the patients diagnosed within the first
year of life were followed for three to five years before
undergoing surgery. Three patients presented after nine years
of age and underwent surgical repair within one year of presentation.
Indications for elective surgical reconstruction included
pain, decreased upper extremity strength, and progressive
deformity. All patients underwent resection of the pseudoarthritis,
autogenous bone grafting, allografting and internal fixation
with a one-third semi-tubular plate or 3.5 reconstruction
plate. Three patients required an intercolary bi-cortical
iliac bone grafting. Average time to healing was 3.1 months
(range 2-5 months). Complications included one bent plate
four weeks post-op due to a fall requiring revision. Six of
eight plates have been removed due to prominence of hardware
or pain with palpation. No statistical difference in clavicular
lengths, shoulder range of motion, and scapulothoracic range
of motion resulted.
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