Clavicle pain

Excerpt

In the case presented, a 16-year-old male with a history of repeated trauma to his left clavicle complained of intermittent and worsening left clavicular pain for several months. He was found to have a nondisplaced clavicle fracture with marked osteolysis on X-ray (Fig. 1) and worked up for a possible neoplasm. An open intralesional biopsy of the area of bone loss was taken and showed bone trabeculae replaced by fibrous connective tissue (Fig. 2a) and prominent vessels lined by a single layer of endothelial cells (Fig. 2b). No neoplastic, acute inflammatory, or infectious process was identified. One month later, he subsequently underwent open reduction and internal fixation with a major autologous bone graft to stabilize the middle segment of his left clavicle (Fig. 3). Lab values were all within normal limits. The patient was started on bisphosphonate. Seven months later, X-ray showed that several of the medially based screws had loosened with progression of osteolysis (Fig. 4). Four screws were subsequently removed from the left clavicle plate. At 11 months after the initial surgery, the patient had complete removal of the hardware (Fig. 5), since his bone resorption had progressed to a point where his clavicle was difficult to visualize on X-ray. After excluding other causes of osteolysis, such as infection, cancer, inflammatory and endocrine disorders, a final diagnosis of Gorham's disease (GD) was made based on the radiographic and histologic findings. …