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PubMed This is a summary of 10 peer-reviewed journal articles Updated
Pediatric Orthopedics · Congenital pseudarthrosis of the clavicle

Treatment Options and Timing

At a Glance

Treatment for congenital pseudarthrosis of the clavicle (CPC) is rarely urgent. Asymptomatic children can be safely monitored, while surgery is reserved for cases involving pain or limited movement. If surgery is needed, waiting until the child is 3 to 5 years old often provides the best results.

Deciding how to manage congenital pseudarthrosis of the clavicle (CPC) is a journey that depends on your child’s symptoms, age, and your family’s preferences. Because CPC is a benign condition, there is rarely a need for urgent treatment [1]. Parents often have time to weigh the options between “watchful waiting” and surgical repair.

The Observation Path (Conservative Management)

If your child is not in pain and can move their arm and shoulder normally, observation is a common and safe approach [2][3].

  • When it’s recommended: Observation is often the first choice for infants and young children who are asymptomatic (showing no symptoms other than the visible lump) [2].
  • The Goal: To monitor for any changes in function, pain, or rare complications like pressure on nerves or blood vessels [4].
  • Long-term Outlook: Many children live with CPC without ever needing surgery. They may have a permanent lump and a slightly shorter collarbone, but they often report excellent functional ability and high satisfaction with their physical activity [2].

The Surgical Path

If you and your doctor decide the bone needs to be joined, surgery is the only effective method [3].

  • When it’s recommended: Doctors typically suggest surgery if the child experiences pain, significant drooping of the shoulder, functional limitations, or if the cosmetic appearance causes emotional distress as the child gets older [5][6].
  • Success Rates: Modern surgical techniques are highly effective, achieving a bone union (the bone pieces growing together) in approximately 87.4% of cases [7].
  • The Procedure: The surgeon typically removes the “false joint” tissue, places a bone graft (often taken from the child’s hip/iliac crest) to fill the gap, and stabilizes the bone using plates, screws, or pins [3][8].

Timing Matters: When to Operate

Timing is a critical part of the conversation with your surgeon. While it may be tempting to “fix it early,” research suggests that waiting can lead to better outcomes.

  • The Case for Waiting: Studies have shown that surgical union rates are higher when the procedure is performed at an older age (often between ages 3 and 5) rather than in infancy [9][10].
  • Why wait? Older children have slightly larger, more mature bones that can better hold the hardware (plates or pins) needed for a stable repair [9]. Operating too early, especially with less stable fixation methods, is associated with a higher risk of the bone failing to join [10][9].

Potential Risks

Like any surgery, repairing CPC carries risks, including infection, scarring, or the bone failing to fuse (non-union) [7]. Your surgical team will help you balance these risks against the benefits of stabilizing the collarbone.

Navigate:

Common questions in this guide

Does congenital pseudarthrosis of the clavicle require immediate treatment?
Because CPC is a benign condition, urgent treatment is rarely needed. For children who are not in pain and can move their arm and shoulder normally, watchful waiting or observation is a safe and common approach.
When is surgery recommended for a child with CPC?
Doctors typically suggest surgery if a child experiences pain, noticeable drooping of the shoulder, or restricted arm movement. It may also be recommended if the visible lump causes significant emotional distress as the child grows older.
What is the best age for CPC surgical repair?
Research shows that waiting until a child is between three and five years old generally leads to better surgical outcomes. Older children have slightly larger, more mature bones that can better hold the plates or pins needed to stabilize the repair.
What happens during surgery for congenital pseudarthrosis of the clavicle?
During the procedure, the surgeon removes the false joint tissue and places a bone graft, usually taken from the child's hip, to fill the space. The collarbone is then stabilized with plates, screws, or pins to help the bone pieces fuse together.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Is my child's case considered 'asymptomatic,' and if so, what are the risks of choosing observation over surgery?
  2. 2.If we decide on surgery, at what age do you recommend performing it to ensure the best chance of the bone healing?
  3. 3.What type of fixation (plates, pins, or wires) do you recommend for my child, and what are the pros and cons of each?
  4. 4.Where will the bone graft be taken from, and what is the recovery like for that site?
  5. 5.What are the specific signs that would move us from 'observation' to 'scheduling surgery' as my child grows?

Questions For You

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References

References (10)
  1. 1

    [When to think about pediatric congenital pseudoarthrosis of the clavicle? Presentation of 2 cases].

    Justich Zabala PR, Giniger Vidal RP, Rubio Pérez MJ, et al.

    Archivos argentinos de pediatria 2020; (118(2)):e194-e198 doi:10.5546/aap.2020.e194.

    PMID: 32199064
  2. 2

    Radiographic and Clinical Outcomes of Non-Operative Treatment for Patients with Non-Union of Fractures of the Mid-Shaft of the Clavicle in Adults.

    Hwang JS, Kim MB, Lee YH

    The journal of hand surgery Asian-Pacific volume 2022; (27(1)):68-75 doi:10.1142/S2424835522500205.

    PMID: 35135419
  3. 3

    Comparison of two methods in the treatment of congenital pseudarthrosis of clavicle: multicenter experience.

    Li J, Tang SP, Mei HB, et al.

    Journal of orthopaedic surgery and research 2021; (16(1)):301 doi:10.1186/s13018-021-02438-x.

    PMID: 33964943
  4. 4

    Thoracic Outlet Syndrome Secondary to Vascular Insufficiency from Congenital Pseudarthrosis of the Clavicle: A Case Report.

    Hysong AA, Denduluri SK, Arko FR, et al.

    JBJS case connector 2023; (13(2)) doi:10.2106/JBJS.CC.22.00426.

    PMID: 37279298
  5. 5

    Congenital pseudarthrosis of the clavicle: a systematic review.

    Assouto C, Bertoncelli CM, Gauci MO, et al.

    International orthopaedics 2022; (46(11)):2577-2583 doi:10.1007/s00264-022-05470-6.

    PMID: 35701591
  6. 6

    Congenital Pseudarthrosis of the Clavicle: A Case Report and a Hypothesis for the Right-Side Predominance.

    Al-Abdi SY, Khalil AM, Elnamky AN, Sherif KE

    Cureus 2022; (14(9)):e29157 doi:10.7759/cureus.29157.

    PMID: 36259035
  7. 7

    Congenital Pseudarthrosis of the Clavicle in Children: A Systematic Review.

    Depaoli A, Zarantonello P, Gallone G, et al.

    Children (Basel, Switzerland) 2022; (9(2)) doi:10.3390/children9020147.

    PMID: 35204869
  8. 8

    Surgical Management of Congenital Pseudoarthrosis of the Clavicle: A Review of Current Concepts.

    Alsaeed AA

    Cureus 2021; (13(10)):e18482 doi:10.7759/cureus.18482.

    PMID: 34754644
  9. 9

    Congenital pseudarthrosis of the clavicle: surgical decision making and outcomes.

    Kim AE, Vuillermin CB, Bae DS, et al.

    Journal of shoulder and elbow surgery 2020; (29(2)):302-307 doi:10.1016/j.jse.2019.06.002.

    PMID: 31427229
  10. 10

    Surgical treatment of congenital pseudarthrosis of the clavicle: A series of 10 cases.

    Payen M, Mainard N, Accadbled F, et al.

    Orthopaedics & traumatology, surgery & research : OTSR 2024; (110(6)):103518 doi:10.1016/j.otsr.2022.103518.

    PMID: 36528260

This page provides general information about treatment options and timing for congenital pseudarthrosis of the clavicle (CPC). Always consult a pediatric orthopedic surgeon to determine the safest and most effective treatment plan for your child's specific needs.

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