Congenital pseudoarthrosis of the clavicle with bifurcation
Congenital pseudoarthrosis of clavicle associated with bifurcation is an atypical anatomic variant. According to the authors, this variant has never been mentioned in the literature. In the present report, published in the Indian Journal of Orthopaedics, the authors we have described this subtype of symptomatic congenital pseudoarthrosis of the clavicle with bifurcation and its possible management.

A 21 year old female patient presented with right sided shoulder pain, aggravated by overhead activity and lifting heavy weights. It was associated with occasional paraesthesia of the ring and little fingers on the right side. On examination, a bony hard lump was palpable in the middle third of right clavicle with an indentation, which was present since birth. An abnormal mobility was present between the sternal and acromial ends of clavicle.

Plain radiographs revealed two areas of pseudoarthrosis in the middle of clavicle. The clavicle was bifid in its middle and separated from the sternal fragment through false joints. The edges of false joints were rounded. The inferior part was broad and more rounded than its superior counterpart. MRI scan revealed compression of nerve roots inferiorly at the pseudoarthrosis site.

The patient underwent surgery in the supine position on a radiolucent table with a sheet bolus under the shoulder. Through an 8 cm direct incision over the abnormal bony lump of the clavicle, the pseudoarthrosis was exposed. Fibrous tissue was resected from the pseudoarthrosis and frank abnormal mobility could be elicited, in both the superior and the inferior parts. Inferior part of the bifid clavicle was osteotomized and resected in an attempt to decompress the brachial plexus.

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