Post-Traumatic Osteolysis of the Clavicle

Propionibacterium acnes–mediated distal clavicular osteolysis: a case report

“…[7][8][9]11,13 However, because of lack of sufficient evidence, Cahill's theory of osteolysis induced by microfractures in the subchondral bone still remains the most accepted.…”

Successful treatment of the post-traumatic osteolysis of distal clavicle with alendronate

“…7 Asano et al reported the presence of inflammatory cells in bone marrow of both clavicle and acromion, fibrous tissue with vascular proliferation covering the distal clavicle and the presence of multinuclear giant cells 5 months after the injury, 3 while Levine et al showed that after 18 months of the initial trauma there was evidence for vascular proliferation, periosteal hypertrophy, villous hyperplasia and tiny fragments of necrotic bone. 12 Others have suggested bone and articular cartilage destruction and replacement by fibrous tissue, detritus in marrow spaces, subchondral cyst formation and sclerotic bone generally viewed as indicative of avascular necrosis.…”

“…19 It is thus exciting that several authors have reported the existence of inflammatory cells in the bone marrow of distal clavicle during the post-traumatic osteolysis. 3,7 A chronic inflammation may also lead to a local lactate production and acidic environment formation, which would stimulate osteoclasts and contribute to the mineralized matrix dissolution directly as well. 2 Our results suggest that no matter what mediators are associated with the osteolytic process, the cellular pathway in osteolysis involves in the end the activity of the osteoclast and as long as the pharmaceutical agent can inhibit the osteoclast function, improvement could be anticipated.…”

“…Osteolysis of the distal clavicle has also been reported in patients with a history of weight lifting, baseball, handball, pneumatic jackhammer use and also spinal cord injury. [5][6][7]15,17,18 In these cases, the longstanding stress on upper extremity has been suggested to lead to repetitive microtrauma with a consequence of osteolysis.…”

Diagnosis and Management of Distal Clavicle Osteolysis

“…With the rise in popularity and familiarity of arthroscopy, as well as its proposed advantages noted earlier, both indirect (subacromial/bursal) and direct (superior) approaches have been described. 24,[29][30][31][32] In the indirect approach, a traditional posterior shoulder arthroscopy portal is established, and the combination of both anterolateral and anteroinferior portals are used to optimize visualization of the distal clavicle within the subacromial space. Typically, decompression and debridement are performed from inferior to superior, with medial decompression being performed last to ensure adequate decompression.…”