Congenital pseudarthrosis of the clavicle is a rare entity of unknown aetiology. Its pathogenesis is related to the embryology of the clavicle. We present a 6-year-old girl with congenital pseudarthrosis of the right clavicle. A prominence was noticed at birth between the middle and distal ends of the clavicle that increased in size when the right shoulder was actively mobilised. Radiographic examination revealed a hypertrophic pseudarthrosis of the clavicle. The pseudarthrosis was resected and the clavicular segments were fixed with an external fixator for 2 months until union. Clinical results were excellent at the 7-year follow-up: the right shoulder was pain-free and the appearance satisfactory. Surgical treatment of congenital pseudarthrosis of the clavicle in children using an external fixator provides a better cosmetic outcome with smaller postoperative scars and avoids a second surgical procedure to remove the implants.

The authors reviewed 83 physeal and epiphyseal injuries of the distal tibia with intra-articular involvement. The children, aged 11 to 14 years, were treated in the authors' department during 1987 to 1999. Treatment was nonoperative for 72.25% (60/83) and surgical for 27.75% (23/83) according to specific indications. This gives the basis for a classification of these injuries. The main purpose of the study was to investigate the long-term results of these injuries according to a radiologic classification. The parameters considered were the patient's age, the mechanism of injury, and the possibility of growth deformities or functional disorders. They were studied relative to the long-term results, with a follow-up of 2 to 13 years. Regardless of treatment, varus deformity, ranging from 10 to 15 degrees in relation to the normal opposite leg, occurred in four cases. In only one case was there painful limitation of ankle joint movement; in two other children an overgrowth of the medial malleolus was detected, with no functional impairment.

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Forty-five children with combined fractures of the proximal end of the radius and ulna were treated in our orthopedic department over a period of 16 years (1984-1999). The age of the patients ranged from 5 to 12 years (mean 8 years) with a peak of 7-8 years. The mechanism of injury was a fall on the outstretched hand with the elbow extended and with a valgus force being applied to the elbow. In 35 patients, closed reduction or immobilization in plaster, or both, were performed. In the other 10 patients, a surgical treatment was followed either for fractures of the radius (4) or for both the radius and ulna (6). The follow-up period ranged from 4 to 20 years (mean 12 years 3 months). The functional results were satisfactory in most cases despite the poor radiological appearance of some of them. In three patients we found a notable restriction, mainly in forearm pronation-supination and less in elbow flexion-extension, because of upper radioulnar joint synostosis. Poor results related with initial damages at the time of injury and the age of the patient (> 10 years) rather than with the way of treatment. Valgus deformity, restriction in flexion-extension, and pronation-supination were related with the extent of the initial injury but not related with the way of treatment. Overgrowth of the radial head, which had minor impact mainly on the pronation-supination, was found in the majority of cases that underwent surgical treatment. Minor residual abnormalities of the radius, ulna, or both were present without having marked functional influence.