Cédric Assouto1, Carlo Mario Bertoncelli2,3,4, Marc-Olivier Gauci5, Marco Monticone6,7, Sikha Bagui8, Virginie Rampal1, Federico Solla1. 1. Pediatric Orthopaedic Surgery Unit, Lenval University Children's Hospital, Nice, France. 2. Pediatric Orthopaedic Surgery Unit, Lenval University Children's Hospital, Nice, France. bertoncelli@unice.fr. 3. Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, USA. bertoncelli@unice.fr. 4. Hôpital Pour Enfants - E.E.A.P. H. Germain, 337 Chemin Saint Antoine de Ginestiere, 06200, Nice, France. bertoncelli@unice.fr. 5. Orthopaedic Surgery Unit, Pasteur University Hospital, Nice, France. 6. Medical Sciences and Public Health, Physical Medicine and Rehabilitation, University of Cagliari, Cagliari, Italy. 7. Neuroscience and Rehabilitation, Neurorehabilitation Unit, G. Brotzu Hospital, Cagliari, Italy. 8. Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, USA.
Abstract
PURPOSE: There is no consensus on the type of surgical treatment of congenital pseudarthrosis of the clavicle due to its rarity. The purpose of this study is to provide evidence in favor of a surgical technique and to explore factors correlated with bone consolidation. METHODS: Systematic review of the literature and an analysis of the data for each subject, including all available subjects from the published series and clinical cases since 1990. Fisher's exact tests or T-tests were used to evaluate the effect of independent variables (age at surgery and type of treatment) on bone healing. RESULTS: The literature search provides 305 articles; 30 were selected, reporting 191 patients and 194 clavicles. One hundred and fifty-one clavicles were operated on at a mean age of nine years and four months (from 8 months to 21 years). Thirteen clavicles (8, 6%) had not consolidated at the last follow-up. Concerning the type of fixation, the rate of healing was similar for plates and pins (p = 0.27). The rate of consolidation was higher with autograft than with allograft, xenograft, or no graft (p = 0.00001), and was 100% for vascularized graft. The mean age at surgery was higher for patients who healed at the last follow-up (118 vs. 61 months, p = 0.001). CONCLUSION: In the event of surgical indication for congenital pseudarthrosis of the clavicle, it is recommended to perform autograft and stable fixation (level 4) after seven years old (level 4).
PURPOSE: There is no consensus on the type of surgical treatment of congenital pseudarthrosis of the clavicle due to its rarity. The purpose of this study is to provide evidence in favor of a surgical technique and to explore factors correlated with bone consolidation. METHODS: Systematic review of the literature and an analysis of the data for each subject, including all available subjects from the published series and clinical cases since 1990. Fisher's exact tests or T-tests were used to evaluate the effect of independent variables (age at surgery and type of treatment) on bone healing. RESULTS: The literature search provides 305 articles; 30 were selected, reporting 191 patients and 194 clavicles. One hundred and fifty-one clavicles were operated on at a mean age of nine years and four months (from 8 months to 21 years). Thirteen clavicles (8, 6%) had not consolidated at the last follow-up. Concerning the type of fixation, the rate of healing was similar for plates and pins (p = 0.27). The rate of consolidation was higher with autograft than with allograft, xenograft, or no graft (p = 0.00001), and was 100% for vascularized graft. The mean age at surgery was higher for patients who healed at the last follow-up (118 vs. 61 months, p = 0.001). CONCLUSION: In the event of surgical indication for congenital pseudarthrosis of the clavicle, it is recommended to perform autograft and stable fixation (level 4) after seven years old (level 4).