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Posttraumatic cleidoscapular synostosis following a fracture of the clavicle. A case report.

Fractures of the clavicle are common in both children and adults; such fractures accounted for 43 percent of 1603 injuries of the shoulder girdle as reported by Rowe11 in 1958. Most fractures of this type heal uneventfully as noted by Hippocrates1 in 400 B.C. Several late complications have been identified, including nonunion, malunion, neurovascular compromise, and posttraumatic arthritis3. We report the case of a child in whom a cleidoscapular synostosis developed following a segmental fracture of the clavicle; this complication has not been reported previously, to our knowledge.

An eight-year-old girl was seen in January 1995 for the evaluation of a deformity of the left shoulder, which was occasionally painful at night and during cold weather. Two years earlier, she had been injured while riding as a passenger in the backseat of an automobile that was broadsided by another vehicle; she was not wearing a seat belt at the time of the accident. She sustained an injury of the left shoulder and a minor injury of the head; medical evaluation revealed a fracture of the left clavicle and a small extradural hematoma without a fracture of the skull. She was observed as an inpatient for three days and was discharged with the left arm in a sling. During the following year she was evaluated by two orthopaedic surgeons, who recommended physical therapy.

Our examination revealed a fixed winging deformity of the left scapula, with a palpable mass along the anterosuperior aspect of that bone. The …