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Congenital pseudarthrosis of the clavicle: a systematic review

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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).

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Data availability

No availability of data and materials.

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Author information

Authors and Affiliations

  1. Pediatric Orthopaedic Surgery Unit, Lenval University Children’s Hospital, Nice, France

    Cédric Assouto, Carlo Mario Bertoncelli, Virginie Rampal & Federico Solla

  2. Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, USA

    Carlo Mario Bertoncelli & Sikha Bagui

  3. Hôpital Pour Enfants - E.E.A.P. H. Germain, 337 Chemin Saint Antoine de Ginestiere, 06200, Nice, France

    Carlo Mario Bertoncelli

  4. Orthopaedic Surgery Unit, Pasteur University Hospital, Nice, France

    Marc-Olivier Gauci

  5. Medical Sciences and Public Health, Physical Medicine and Rehabilitation, University of Cagliari, Cagliari, Italy

    Marco Monticone

  6. Neuroscience and Rehabilitation, Neurorehabilitation Unit, G. Brotzu Hospital, Cagliari, Italy

    Marco Monticone

Authors
  1. Cédric Assouto
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  2. Carlo Mario Bertoncelli
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  3. Marc-Olivier Gauci
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  4. Marco Monticone
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  5. Sikha Bagui
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  6. Virginie Rampal
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  7. Federico Solla
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Contributions

All the authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Federico Solla and Carlo Bertoncelli. The first draft of the manuscript was written by Cédric Assouto and Federico Solla, and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Cédric Assouto performed the study and wrote the article.

Marc-Olivier Gauci supervised the study, wrote, and revised the article.

Sikha Bagui supervised the study, wrote, and revised the article.

Marco Monticone supervised the study, wrote, and revised the article.

Carlo Mario Bertoncelli supervised the study and revised the text.

Virginie Rampal supervised the study and revised the text.

Federico Solla conceived and supervised the study, wrote, and revised the text.

Corresponding author

Correspondence to Carlo Mario Bertoncelli.

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Ethics approval and consent to participate

The present study did not require ethics approval.

Informed consent was obtained from all individual participants included in the study.

The authors affirm that human research participants provided informed consent for publication of the images in Fig. 1, 2, 3 and 4.

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The authors declare no competing interests.

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Assouto, C., Bertoncelli, C.M., Gauci, MO. et al. Congenital pseudarthrosis of the clavicle: a systematic review. International Orthopaedics (SICOT) 46, 2577–2583 (2022). https://doi.org/10.1007/s00264-022-05470-6

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  • DOI: https://doi.org/10.1007/s00264-022-05470-6

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