[Surgical treatment of congenital clavicular pseudarthrosis]

Congenital pseudarthrosis of the clavicle is an extremely rare disease of unknown histogenesis. The method of treatment is still discussed controversely.

Two cases of a congenital pseudarthrosis of the right clavicle were presented, revealing the typical clinical, radiologic and histopathologic features. Surgical treatment was performed at the age of 4 and 7 years, consisting of a partial resection of the bony ends of both segments of the clavicle, partial excision of the dense fibrous tissue lying within the defective area in the middle third of the clavicles by forming a continuous sleeve for interposing autogeneous spongiosa from the iliac crest and internal fixation with a Kirschner wire. Both cases showed a successful solid bone union in X-ray controls after 8 weeks.

According to the histopathological findings we assume an abnormal ineffective chondral instead of an endesmal ossification resulting from a damage during embryogenesis as the underlying pathogenetic mechanism of congenital pseudarthrosis of the clavicle. Since chondral ossification proves to be ineffective also after birth, spontaneous bony union cannot be expected. Therefore, reconstructive surgery is the treatment of choice.