A 6 month old girl initially presented to the GP when her mum found a small lump over her right clavicle. The girl was otherwise well with no developmental concerns, was pain free and using both her arms. She was delivered non traumatically by forceps with no suggestions of injury post-natally.
The girl was otherwise well with no social concerns in the family.
The GP had organised an ultrasound of the clavicle in the first instance which took some 3 weeks to be conducted. The ultrasound was reported to find a “gap in the clavicle measuring 12 mm between the medial and lateral third” and suggested an x-ray.
The x-ray conducted a few days later was reported as “an extensive fracture of the middle third of the clavicle with moderate displacement of the medial and lateral ends with no callus”. Following this the girl was referred to the Paediatricians (See Figures 1 and 2).
The history was reviewed with parents who confirmed the birth history, developmental history and that no trauma had taken place. The parents could not explain how their child could have possibly sustained a clavicular injury.
Examination revealed a happy active child with symmetrical arm movements. There was no weakness of the right arm. There was a small 3–5 mm bony like lump on the medial section of her right clavicle.
Social services were informed of the presentation who insisted on child protection proceedings to begin. Following this the Paediatric team involved the Orthopaedic team who on review of the child and the x-rays diagnosed Congenital Pseudoarthrosis Of The Clavicle and child protection proceedings were halted. She will be followed up by the orthopaedic team locally.
On review of the literature the condition is rare, usually affects girls and is almost always on the R side.1 This novel presentation demonstrates that at times full MDT input is vital for full interpretation of investigations prior to child protection proceedings taking place in cases of suspected NAI.
Magu NK, Singla R, Devgan A, Gogna P. Congenital pseudoarthrosis of the clavicle with bifurcation. Indian J Orthop 2014;48:435–7
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