title: Salvage reconstruction of congenital pseudarthrosis of the clavicle with vascularized fibular graft after failed operative treatment: a case report.
abstract: Congenital pseudarthrosis of the clavicle is a rare condition present at birth but often diagnosed later in childhood. Indications for surgical treatment include deformity, pain, or neurovascular compromise. Reconstruction usually involves resection of the pseudarthrosis, placement of iliac crest bone graft, and internal fixation. We report a case of congenital pseudarthrosis of the clavicle that failed initial surgical management at another institution using bone marrow aspirate, bone graft substitute, and internal fixation with plate and screws. Treatment failure was associated with significant osteolysis resulting in a large defect of the midclavicle with only small areas of residual bone remaining at the medial and lateral ends, and the remaining hardware was mobile. The defect was judged to be too large for placement of an iliac crest bone graft and was therefore spanned with a free vascularized fibular graft. At 15 months postoperatively, the patient has clinical and radiographic unions, and is symptom-free with an excellent cosmetic result. This unique application of a well-established technique provided a successful solution to this difficult revision situation.
  
  
  METHODS
  Level V, case report.
authors.affiliation: Harvard Combined Orthopaedic Residency Program, Boston, MA, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Glotzbecker
authors.forename: Eon K
authors.initials: EK
authors.lastname: Shin
authors.forename: Neal C
authors.initials: NC
authors.lastname: Chen
authors.forename: Brian I
authors.initials: BI
authors.lastname: Labow
authors.forename: Peter M
authors.initials: PM
authors.lastname: Waters
mesh_terms: D016025:Bone Transplantation / Q000379:methods*; D002675:Child, Preschool; D002968:Clavicle / Q000601:surgery*; D005260:Female; D005360:Fibula / Q000098:blood supply / Q000637:transplantation; D005500:Follow-Up Studies; D006801:Humans; D010014:Osteolysis / Q000209:etiology / Q000601:surgery; D011542:Pseudarthrosis / Q000151:congenital / Q000601:surgery* / Q000628:therapy; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome