Clavicle fracture following neck dissection: imaging features and natural course

Abstract

Objective: This study aimed to assess the imaging features and natural course of clavicle fracture following neck dissection (ND). Methods and materials: Eight patients with clavicle fracture following ND were included. Because bilateral clavicle fractures occurred in one patient, a total of nine clavicle fractures following ND were assessed using CT images. Pathological fracture due to bone metastasis or local recurrence was carefully ruled out. Results: The time interval from ND to clavicle fracture ranged from 2 to 8 months (median, 4 months). On CT images, all the nine fractures occurred in the proximal clavicles and displayed increased bone marrow density with extraosseous soft-tissue mass formation. Osteolysis of the clavicle was not observed. Intra articular fractures were observed in three (33%), displaced fractures in two (22%), and free bone fragments in three (33%) cases. Further follow-up using CT showed that six (67%) fractures resulted in pseudoarthrosis. For the remaining three (33%) fractures with bone union during follow-up, the time interval between clavicle fracture and bone union ranged from 4 to 16 months (median, 6 months). Conclusion: Proximal clavicle fractures, which are rarely observed following ND, always display extraosseous soft-tissue mass formation without osteolysis. They frequently result in pseudoarthrosis; however, occasionally, they also result in bone union within 24 weeks. Advances in knowledge: The location of proximal clavicle, the lack of osteolysis, and the presence of free bone fragments may be the key to diagnosis of clavicle fracture following ND.

Medial clavicle fracture with bone destruction after radical neck dissection combined with postoperative chemotherapy for secondary cervical lymph node metastasis of tongue cancer: a case report

“…However, similar cases of CF after neck dissection have been reported by other researchers [4,5,[7][8][9][10][11][12][13][14][15], who advocated various hypotheses regarding their causes.…”

“…The pathogenesis of bone destruction in CF after neck dissection might be associated with multiple factors, and the cause for the bone destruction in the current patient has not yet been identified. However, comparing the present and previous cases of CF, our case suggests that postoperative chemotherapy after RND might contribute to bone destruction in CF, even in the absence of radiotherapy [8,16] and infection [14] of the clavicle. The influence of chemotherapy on the occurrence of CF after neck dissection remains unknown.…”

“…Strauss et al [5] and others [4,7,8,14] considered that CF after neck dissection was a result of weakening of the bone and blood supply caused by neck dissection and/or radiotherapy. However, the current patient did not receive radiation therapy.…”

“…However, the current patient did not receive radiation therapy. Other reports of medial CF after neck dissection indicated that neck dissection alone might cause such fractures, with or without postoperative radiotherapy [11,14].…”

“…Fujimoto et al's [14] study was also relevant to the association between CF after neck dissection and bone destruction. They assessed the CT images of nine cases of CF following neck dissection and suggested that proximal CF consistently showed an extraosseous soft-tissue mass formation without bone destruction on CT [14]. In our case, the patient had no subjective symptoms related to the fracture, despite the formation of an extraosseous soft-tissue mass, as in Fujimoto et al's cases.…”