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Similarities and Differences between Clavicular Bacterial Osteomyelitis and Nonbacterial Osteitis: Comparisons of 327 Reported Cases. J Immunol Res 2021; 2021:4634505. [PMID: 33575360 PMCID: PMC7857900 DOI: 10.1155/2021/4634505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 01/03/2021] [Accepted: 01/09/2021] [Indexed: 12/19/2022] Open
Abstract
Background Currently, both clavicular bacterial osteomyelitis (BO) and nonbacterial osteitis (NBO) remain not well understood owing to their much lower incidences. This study is aimed at summarizing similarities and differences between clavicular BO and NBO based on comparisons of literature-reported cases. Methods We searched the PubMed and Embase databases to identify English published literature between January 1st, 1980, and December 31st, 2018. Inclusion criteria were studies evaluating clinical features, diagnosis, and treatment of clavicular BO and NBO, with eligible data for synthesis analysis. Results Altogether, 129 studies with 327 patients were included. Compared with BO, clavicular NBO favored females (P < 0.001) and age below 20 years (P < 0.001) and mostly presented in a chronic phase (disease term exceeding 2 months) (P < 0.001). Although local pain and swelling were the top two symptoms for both disorders, fever, erythema, and a sinus tract were more frequently found in BO patients (P < 0.01). Although they both favored the medial side, lesions in the clavicular lateral side mostly occurred in BO patients (P = 0.002). However, no significant differences were identified regarding the serological levels of white blood cell count (P = 0.06), erythrocyte sedimentation rate (P = 0.27), or C-reactive protein (P = 0.33) between BO and NBO patients before therapy. Overall, the BO patients achieved a statistically higher cure rate than that of the NBO patients (P = 0.018). Conclusions Females, age below 20 years, and a long duration of clavicular pain and swelling may imply NBO. While the occurrence of a sinus tract and lesions in the lateral side may be clues of BO, inflammatory biomarkers revealed limited values for differential diagnosis. BO patients could achieve a better efficacy than the NBO patients based on current evidence.
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Maya GF, Nahmad DL, Or O, Safran O, Beyth S. Friedrich Disease: A Case Report. JBJS Case Connect 2020; 10:e2000027. [PMID: 32865953 DOI: 10.2106/jbjs.cc.20.00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CASE A 16-year-old girl presented with pain and swelling of the medial edge of the clavicle. She denied previous trauma and was evaluated by multiple physicians for a possible infection or neoplastic lesion. The patient underwent multiple studies and procedures, including blood tests, imaging studies, and biopsy. After 6 months, a diagnosis of osteochondrosis of the medial clavicle was made. After 1 year of observation, the symptoms resolved. CONCLUSIONS The rarity of Friedrich disease and the scarcity of literature may lead to delayed diagnosis of this pathology. Awareness of medical personnel of this condition may facilitate accurate diagnosis.
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Affiliation(s)
- Gabriel Fraind Maya
- 1Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Hu WR, Yao ZL, Yu B, Jiang N. Clinical characteristics and treatment of clavicular osteomyelitis: a systematic review with pooled analysis of 294 reported cases. J Shoulder Elbow Surg 2019; 28:1411-1421. [PMID: 30826202 DOI: 10.1016/j.jse.2018.11.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is usually difficult to diagnose clavicular osteomyelitis (OM), and treatment is delayed because of its rarity. This study aimed to summarize clinical characteristics and treatment of this disease. METHODS We searched the PubMed and Embase databases to identify English studies that reported on clavicular OM from January 1980 through December 2016. Effective data were pooled for analysis. RESULTS In total, 111 studies comprising 294 cases (bacterial OM, 146; nonbacterial OM, 148) were included, with a sex ratio of 1.89:1 indicating female predilection. Overall, the median age at diagnosis was 16 years. The acute to chronic phase ratio was 0.30, with a median symptom duration of 4 months. The most frequently reported symptom was pain (192 cases), followed by swelling (151 cases) and fever (52 cases). Altogether, 86.94% cases of single-site involvement were reported, with the medial side being the most common site (69.95%). The erythrocyte sedimentation rate achieved the highest positive rate (74.44%) before treatment. The total positive rate of culture for bacterial OM was 81.82%, with Staphylococcus aureus being the most frequently detected pathogen (44.70%). The average cure rate was 83.52%, with no significant difference between surgical (89.70%) and nonsurgical (79.63%) cases (P = .079). CONCLUSIONS Clavicular OM, predominant in female patients and young people, usually occurred at a chronic stage. Pain was the most frequent symptom, with the medial side being the most involved site. The erythrocyte sedimentation rate may be a helpful indicator for diagnosis. Regardless of surgery or nonsurgery, most patients achieved a favorable prognosis.
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Affiliation(s)
- Wei-Ran Hu
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zi-Long Yao
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Yu
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Nan Jiang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Andreacchio A, Marengo L, Canavese F. Condensing osteitis of the clavicle in children. World J Orthop 2016; 7:494-500. [PMID: 27622150 PMCID: PMC4990771 DOI: 10.5312/wjo.v7.i8.494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/03/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To confirm the rarity of this disorder and then to evaluate the effects of antibiotic treatment alone and assess whether this could produce a complete remission of symptoms in children and adolescents.
METHODS: We made a retrospective review of all cases of condensing osteitis of the clavicle in children and adolescents between January 2007 and January 2016. Outpatient and inpatient medical records, with radiographs, magnetic resonance imaging, triphasic bone scan and computed tomography scans were retrospectively reviewed. All the patients underwent biopsy of the affected clavicle and were treated with intra venous (IV) antibiotics followed by oral antibiotics.
RESULTS: Seven cases of condensing osteitis of the clavicle were identified. All the patients presented with swelling of the medial end of the clavicle, and 5 out of 7 reported persisting pain. The patients’ mean age at presentation was 11.5 years (range 10.5-13). Biopsy confirmed the diagnosis in all cases. All the patients completed the treatment with IV and oral antibiotics. At last follow-up visit none of the patients complained of residual pain; all had a clinically evident reduction in the swelling of the medial end of the affected clavicle. The mean follow-up was 4 years (range 2-7).
CONCLUSION: Our findings show that condensing osteitis of the clavicle is a rare condition. Biopsy is needed to confirm diagnosis. The condition should be managed with IV and oral antibiotics. Aggressive surgery should be avoided.
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Akhtar MN, Agarwal S, Athar R. Clinico-radiological Approach to a Rare Case of Early Clavicle Tuberculosis: A Case Discussion Based Review of Differential Diagnosis. J Clin Diagn Res 2015; 9:RE01-5. [PMID: 26266175 DOI: 10.7860/jcdr/2015/11971.6079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 04/28/2015] [Indexed: 11/24/2022]
Abstract
A patient of 41 years of age presented with insidious onset atraumatic swelling arising from medial end of right clavicle with apparently normal radiograph. Initial computed tomography ascribed it to benign bony pathology requiring no specific treatment but patient did not respond to symptomatic management. FNAC done elsewhere was inconclusive, with no bacteria on Gram's staining and negative bacterial culture and AFB smear examinations. Patient had possible exposure to tuberculosis and Mantoux skin test done which showed significant induration. Possible differential diagnoses related to clavicle including infective, neoplastic, rheumatological, degenerative and idiopathic conditions considered. Magnetic resonance imaging (MRI) showed focal periosteal reaction with marrow signal changes with sparing of sternoclavicular joint. Correlation between patient's history, clinical findings and investigations done and diagnosis of isolated clavicle tuberculosis was made. Patient showed good response to anti-tubercular chemotherapy. Repeat MRI showed resolution of initial imaging findings. At the end of 2 years patient was completely symptom free.
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Affiliation(s)
- Mohammad Nasim Akhtar
- Assistant Professor, Department of Orthopaedics, ESI PGIMSR, ESIC Medical College and ESIC Hospital , The West Bengal University of Health Sciences, Kolkata (W.B.), India
| | - Sharat Agarwal
- Associate Professor, Department of Orthopaedics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences , Shillong (Meghalaya), India
| | - Rizwan Athar
- Consultant Pathologist, Haji Abdul Majid Memorial Hospital , Hojai (Assam), India
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Tuscano D, Banerjee S, Terk MR. Variations in normal sternoclavicular joints; a retrospective study to quantify SCJ asymmetry. Skeletal Radiol 2009; 38:997-1001. [PMID: 19308406 DOI: 10.1007/s00256-009-0689-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 03/06/2009] [Accepted: 03/09/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A wide degree of normal anatomical variation can occur at the sternoclavicular joint (SCJ). On occasion, this has led to concern for a pathological process, potentially resulting in a costly work-up, unnecessary patient worry and invasive diagnostic procedures such as biopsy. The purpose of this study was to determine the normal range of anatomical variation at sternoclavicular joints. MATERIALS AND METHODS One hundred four consecutive patients with chest CT done at our institution were selected. Patients with clear SCJ pathology, chest wall abnormality, CT slice thickness greater than 5 mm and sternotomy wires, were excluded. Chart review was done and showed no SCJ symptoms/signs. We measured the SCJ space, maximum clavicular head diameter within the joint and the distance from manubrium to the anterior margin of the clavicular head. RESULTS Left and right SCJ space ranged from 0.2 to 1.37 cm. The difference (delta or asymmetry) between left SCJ space and right SCJ space ranged from 0 (symmetrical) to 0.57 cm in 104 cases. Left and right clavicular head diameter ranged from 1.2 to 3.7 cm with left/right asymmetry (delta) ranging from 0 (symmetrical) to 1 cm. Manubrium to anterior margin of clavicular head ranged from 0.1 to 2.13 cm with delta ranging from 0 to 0.8 cm. Thirty-three patients demonstrated gas in the joint, five had poor articulation and four had calcification in the joint. CONCLUSION Greater than 10% of patients show substantial asymmetry in the sternoclavicular joints, which may be misinterpreted as pathological. Gas in the joint is a common phenomenon therefore should not be an indication for further work-up in asymptomatic patients and likely excludes the presence of effusion.
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Affiliation(s)
- Daymen Tuscano
- Emory Orthopaedics and Spine Center, Atlanta, NE 30329, USA
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Robinson CM, Jenkins PJ, Markham PE, Beggs I. Disorders of the sternoclavicular joint. ACTA ACUST UNITED AC 2008; 90:685-96. [PMID: 18539660 DOI: 10.1302/0301-620x.90b6.20391] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The sternoclavicular joint is vulnerable to the same disease processes as other synovial joints, the most common of which are instability from injury, osteoarthritis, infection and rheumatoid disease. Patients may also present with other conditions, which are unique to the joint, or are manifestations of a systemic disease process. The surgeon should be aware of these possibilities when assessing a patient with a painful, swollen sternoclavicular joint.
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Affiliation(s)
- C M Robinson
- Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SU, UK.
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Docquier PL, Malghem J, Mousny M, Rombouts JJ. Chronic osteomyelitis of clavicle as primary manifestation of SAPHO syndrome in adolescents: report of four cases and long-term evolution. Joint Bone Spine 2006; 73:756-9. [PMID: 17011808 DOI: 10.1016/j.jbspin.2006.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2005] [Accepted: 01/30/2006] [Indexed: 10/24/2022]
Abstract
Four cases of chronic osteomyelitis of clavicle as primary manifestation of synovitis, acne, pustulosis, hyperostosis, osteomyelitis (SAPHO) are reported in adolescents. In all cases a typical radiographical evolution had been observed with progressive slow migration of sclerotic area from medial to lateral side of clavicle. Long-term evolution was alternation of remission and exacerbation but none of the patients healed.
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Affiliation(s)
- Pierre-Louis Docquier
- Department of Orthopaedic Surgery, Saint-Luc University Hospital, Cliniques Saint-Luc, Universite Catholique de Louvain, 10, avenue Hippocrate, 1200 Brussels, Belgium.
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Harden SP, Argent JD, Blaquiere RM. Painful sclerosis of the medial end of the clavicle. Clin Radiol 2004; 59:992-9. [PMID: 15488847 DOI: 10.1016/j.crad.2004.04.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2004] [Revised: 04/24/2004] [Accepted: 04/30/2004] [Indexed: 11/20/2022]
Abstract
Pain and swelling of the medial end of the clavicle may be associated with radiographic sclerosis. The commonest causes are osteoarthritis, infection and condensing osteitis of the clavicle. Distinguishing between these clinically and radiologically can be difficult but computed tomography (CT) and magnetic resonance imaging (MRI) are often useful for their differentiation. In this review, the typical imaging features of these conditions are presented with an emphasis on the CT and MRI appearances. These are correlated with clinical features, which together should enable a confident diagnosis to be made.
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Affiliation(s)
- S P Harden
- Department of Radiology, Southampton General Hospital, Southampton, UK.
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Affiliation(s)
- Fernando Hiramuro-Shoji
- Department of Orthopaedics, University of Texas Health Science Center at San Antonio, Texas, USA
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Rand T, Schweitzer M, Rafii M, Nguyen K, Garcia M, Resnick D. Condensing osteitis of the clavicle: MRI. J Comput Assist Tomogr 1998; 22:621-4. [PMID: 9676456 DOI: 10.1097/00004728-199807000-00021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Condensing osteitis of the clavicle is a rare benign disorder, seen exclusively in women and characterized by expansion and sclerosis of the medial end of the clavicle. The aim of this study was to evaluate the MR findings of this disorder. METHOD MR images, obtained in four patients with evidence of condensing osteitis of the clavicle based on plain radiographs and clinical symptoms, included pre- and postcontrast T1 SE sequences, T2 SE images, GE images. RESULTS MR images revealed consistent hypointense areas on T1-weighted SE images, corresponding to regions of clavicular sclerosis (n = 4). T2-weighted SE images showed signal characteristics ranging from low intermediate signal intensity in regions of sclerosis (n = 4). T2-weighted GE images revealed moderate to high signal intensity presumably related to bone marrow edema (n = 2). Contrast-enhanced T1-weighted SE images were characterized by mild to extensive intraosseous and periosseous enhancement of signal intensity (n = 2). CONCLUSION MRI in cases of condensing osteitis of the clavicle reveals variable findings perhaps indicative of different stages of activity in this disease.
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Affiliation(s)
- T Rand
- Department of Radiology, Veterans Affairs Medical Center, San Diego, CA 92161, USA
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Jurik AG. Noninflammatory sclerosis of the sternal end of the clavicle: a follow-up study and review of the literature. Skeletal Radiol 1994; 23:373-8. [PMID: 7939838 DOI: 10.1007/bf02416996] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The cases of 14 adult females with swelling, tenderness, and sclerosis of the inferomedial part of the clavicle are presented. They were seen during a 16-year period, suggesting that the condition is rare. In ten patients strain at the sternoclavicular joint seemed to be an etiological factor. Eleven patients were followed for periods of 1-13 years (mean 5 years). The clavicular sclerosis regressed and they all developed signs of osteoarthrosis. Based upon available biopsy results and review of reported cases, it is hypothesized that the radiographic changes are due to osteonecrosis of the medial end of the clavicle with subsequent development of osteoarthrosis.
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Affiliation(s)
- A G Jurik
- Department of Diagnostic Radiology, Municipal Hospital, University of Aarhus, Denmark
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