Congenital pseudarthrosis of the clavicle (CPC) is a rare disorder with an unknown etiology, which is caused by a failure of the clavicle ossification nuclei union process. This is the first CPC twin instance documented in Saudi Arabia, and the fourth overall. In the 33rd week, a set of twins was born prematurely with respiratory distress syndrome. They were both admitted to the neonatal intensive care unit. X-rays of the chest were taken, and the clavicular deformity was discovered. Because the twins were born via a cesarean section, a traumatic clavicular fracture was ruled out. The family members were evaluated, and the same defect was discovered in the father as well, highlighting a genetic predisposition.

Congenital pseudarthrosis of the clavicle (CPC) is rare. It predominantly affects the right side for an unknown reason. Most of the reported cases are diagnosed outside the neonatal period. Only two CPC cases have been reported in Saudi Arabia, where both were diagnosed during childhood. Here, we present the case of a Saudi male newborn with right-sided CPC. The diagnosis was made shortly after birth because of the uneventful cesarean delivery and painless clavicular lump. Fetuses prefer keeping their head in a right lateral position which may be a plausible explanation for the right-side predominancy in the CPC.

BACKGROUND: Congenital pseudarthrosis of the clavicle (CPC) is a rare congenital entity with unresolved aetiology and pathogenesis. Nearly 250 cases have been reported to date. CPC is characterized by a definite defect in the mid-clavicle at birth and is usually diagnosed when the deformity becomes evident in late childhood or adolescence. Surgical management is controversial, especially in asymptomatic children, with various techniques reported in the literature.
METHODS: We report a case of a 6-year-old boy who was diagnosed with CPC during a medical examination for primary school enrollment. Operative treatment included debridement of pseudoarthrosis, internal fixation with third tube plate, and barrel-shaped mono-cortical iliac crest autograft.
RESULTS: A complete bone union was obtained 9 months after the operation, and satisfactory function and cosmetic appearance were observed 4 years and 3 months postoperatively.
CONCLUSIONS: In our opinion, reconstruction with barrel-shaped mono-cortical iliac crest autograft was an effective and reproducible surgical technique to treat CPC.

BACKGROUND: Congenital pseudarthrosis of the clavicle is rare and popular surgical options include excision of the non-union, iliac crest bone grafting and stabilisation with either a fully threaded pin or stabilisation with a reconstruction plate.
METHODS: Between 1995 and 2009, ten patients with congenital pseudarthrosis of the clavicle were retrospectively reviewed for outcome of two different forms of surgical management. Five patients had excision of the non-union, iliac crest bone grafting and stabilisation with a fully threaded pin (group A) and the other five patients had excision of the non-union, iliac crest bone grafting and stabilisation with a reconstruction plate (group B). One patient in the second group had bilateral pseudarthrosis.
RESULTS: In group A, three patients achieved radiological union at a median of 6 months. Two patients failed to unite at the pseudarthrosis and one of them had further surgery with a reconstruction plate in order to achieve union. In group B, all five patients (six clavicles) achieved radiological union at a median of 3 months. All patients had painless full range of shoulder movement and were engaging in unrestricted activities.
CONCLUSIONS: Excision of the pseudarthrosis, autogenous iliac bone grafting and stabilisation with plate achieves union quicker and with lower incidence of complications compared to excision of the pseudarthrosis, autogenous iliac bone grafting and stabilisation with fully threaded pins.