Osteomyelitis of the Clavicle

Abstract

\s=b\ Osteomyelitis of the clavicle is a rare entity and can occur as a complication of head and neck surgery. Ten consecutive cases of the clavicular osteomyelitis were reviewed at the over the past seven years. Six cases were associated with prior surgical procedures, and five cases presented as chronic wound drainage. One case was related to a pharyngocutaneous fistula following a supraglottic laryngectomy. Four patients presented with acute symptoms resulting from hematogenous spread, and two of the four patients had Staphylococcus aureus on blood cultures. Long-term intravenous antibiotic therapy (six to eight weeks) was used to successfully treat cases of hematogenously spread osteomyelitis. Wide surgical d\l=e'\bridementwas the mainstay of treatment in the chronic conditions, with antibiotic therapy having a secondary role. Myocutaneous flaps were required in two patients who had had surgery and antecedent radiotherapy. To conclude, the surgeon should be aware that osteomyelitis of the clavicle can occur as a complication of head and neck procedures. In addition, the treatment of the chronic form of clavicular osteomyelitis is surgical d\l=e'\bridementand possible flap reconstruction. 90024 (Dr Calcaterra). Clavicular osteomyelitis is a rare entity that poses a significant diagnostic and therapeutic challenge to the head and neck surgeon. Osteo¬ myelitis of the clavicle may result from either the hematogenous or con¬ tiguous spread of a bacterial infection. The latter is becoming more frequent¬ ly recognized, being associated with the increased use of subclavian punc¬ tures for central venous access and large extirpative head and neck proce¬ dures.1·2 Diagnosis of osteomyelitis associated with a draining sinus tract has led to the development of more sophisticated radionucleotide studies.3 Also, experiments indicate that many cases of osteomyelitis are best treated by surgical débridement and vascular¬ ized flap coverage of the resultant defect.4Advances in the diagnosis of clavic¬ ular osteomyelitis and both the anti¬ biotic and surgical treatment of the disease have had an influence on its current management. To assess the status of this disease at our institu¬ tion, the recent experience at the Uni¬ versity of California, Los Angeles Center for the Health Sciences, was reviewed. MATERIALS AND METHODSA retrospective chart analysis of all patients treated at our institution with the clinical diagnosis of clavicular osteomyeli¬ tis was performed. The study period cov¬ ered seven years, from 1980 to 1987. Ten patients were identified as having osteo¬ myelitis of the clavicle. Their charts were reviewed, and clinical data on microbacteriology, histopathology, radiographie studies, treatment, and follow-up were obtained. A case report is presented that demonstrates the use of vascularized mus¬ cle flaps in the treatment of clavicular osteomyelitis. REPORT OF A CASEA 69-year-old man presented to us with otalgia, dysphagia, and odynophagia and was found to have squamous cell carcino¬ ma of the left vallecula, w...

Osteomyelitis of the clavicle: clinical, radiologic, and bacteriologic findings in ten patients

“…As in osteomyelitis at other sites, Staphylococcus aureus is the predominant causal agent in clavicular infections [1,2,8,11,19], and this is valid for all age groups. /3-hemolytic streptococci [19]; mixed flora, including Bacteroides fragilis and Pseudornonas aeruginosa [1,2,15,22,26]; Propionibacterium acnes [1,14]; Serratia marcescens [21,28]; Treponema pallidum (syphilis) [22]; Mycobacteriurn tuberculosis [16,22,25]; and fungi [6,7,18] have also been reported in the literature.…”

Appearances are Deceptive: Staphylococcus Superinfection of Clavicular Tuberculous Osteomyelitis

“…[8][9][10] The medial half of the clavicle seems to be the most commonly affected site, although any portion may be affected. [10][11][12] Osteomyelitis of the clavicle can occur due to hematogenous or contiguous spread as well as direct inoculation. 12 In children, its origin is generally hematogenous, while in adults, clavicular osteomyelitis is more commonly seen in association with a predisposing factor, such as systemic coccidioidomycosis, intravenous drug abuse, TB, mitral valve prosthesis, diabetes, previous lung carcinoma, or prior head and neck surgical procedures.…”

“…[10][11][12] Osteoarticular tuberculosis is thought to be due to the reactivation of dormant organisms. [11][12][13] The risk factors for the development of TB include recent TB contact, emigration from endemic areas, previous pulmonary TB, HIV infection, lower socioeconomic class, homelessness, and imprisonment.…”

“…[10][11][12] Osteoarticular tuberculosis is thought to be due to the reactivation of dormant organisms. [11][12][13] The risk factors for the development of TB include recent TB contact, emigration from endemic areas, previous pulmonary TB, HIV infection, lower socioeconomic class, homelessness, and imprisonment. [11][12][13] Our patient had emigrated from India, making it possible that he had been infected in his country of origin and that this infection was subclinical, since he had no previous history of TB, and his chest radiograph was normal.…”

Post-traumatic osteomyelitis of the clavicle: A case report and review of literature

“…Osteomyelitis of the clavicle is a rare entity and can occur as a complication of head and neck surgery (3)(4)(5), and of subclavian vein catheterization (6)(7)(8). Soft tissue infections around the puncture site occur frequently and respond well to topical and antibiotic treatment.…”