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Similarities and Differences between Clavicular Bacterial Osteomyelitis and Nonbacterial Osteitis: Comparisons of 327 Reported Cases. J Immunol Res 2021; 2021:4634505. [PMID: 33575360 PMCID: PMC7857900 DOI: 10.1155/2021/4634505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 01/03/2021] [Accepted: 01/09/2021] [Indexed: 12/19/2022] Open
Abstract
Background Currently, both clavicular bacterial osteomyelitis (BO) and nonbacterial osteitis (NBO) remain not well understood owing to their much lower incidences. This study is aimed at summarizing similarities and differences between clavicular BO and NBO based on comparisons of literature-reported cases. Methods We searched the PubMed and Embase databases to identify English published literature between January 1st, 1980, and December 31st, 2018. Inclusion criteria were studies evaluating clinical features, diagnosis, and treatment of clavicular BO and NBO, with eligible data for synthesis analysis. Results Altogether, 129 studies with 327 patients were included. Compared with BO, clavicular NBO favored females (P < 0.001) and age below 20 years (P < 0.001) and mostly presented in a chronic phase (disease term exceeding 2 months) (P < 0.001). Although local pain and swelling were the top two symptoms for both disorders, fever, erythema, and a sinus tract were more frequently found in BO patients (P < 0.01). Although they both favored the medial side, lesions in the clavicular lateral side mostly occurred in BO patients (P = 0.002). However, no significant differences were identified regarding the serological levels of white blood cell count (P = 0.06), erythrocyte sedimentation rate (P = 0.27), or C-reactive protein (P = 0.33) between BO and NBO patients before therapy. Overall, the BO patients achieved a statistically higher cure rate than that of the NBO patients (P = 0.018). Conclusions Females, age below 20 years, and a long duration of clavicular pain and swelling may imply NBO. While the occurrence of a sinus tract and lesions in the lateral side may be clues of BO, inflammatory biomarkers revealed limited values for differential diagnosis. BO patients could achieve a better efficacy than the NBO patients based on current evidence.
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Hu WR, Yao ZL, Yu B, Jiang N. Clinical characteristics and treatment of clavicular osteomyelitis: a systematic review with pooled analysis of 294 reported cases. J Shoulder Elbow Surg 2019; 28:1411-1421. [PMID: 30826202 DOI: 10.1016/j.jse.2018.11.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is usually difficult to diagnose clavicular osteomyelitis (OM), and treatment is delayed because of its rarity. This study aimed to summarize clinical characteristics and treatment of this disease. METHODS We searched the PubMed and Embase databases to identify English studies that reported on clavicular OM from January 1980 through December 2016. Effective data were pooled for analysis. RESULTS In total, 111 studies comprising 294 cases (bacterial OM, 146; nonbacterial OM, 148) were included, with a sex ratio of 1.89:1 indicating female predilection. Overall, the median age at diagnosis was 16 years. The acute to chronic phase ratio was 0.30, with a median symptom duration of 4 months. The most frequently reported symptom was pain (192 cases), followed by swelling (151 cases) and fever (52 cases). Altogether, 86.94% cases of single-site involvement were reported, with the medial side being the most common site (69.95%). The erythrocyte sedimentation rate achieved the highest positive rate (74.44%) before treatment. The total positive rate of culture for bacterial OM was 81.82%, with Staphylococcus aureus being the most frequently detected pathogen (44.70%). The average cure rate was 83.52%, with no significant difference between surgical (89.70%) and nonsurgical (79.63%) cases (P = .079). CONCLUSIONS Clavicular OM, predominant in female patients and young people, usually occurred at a chronic stage. Pain was the most frequent symptom, with the medial side being the most involved site. The erythrocyte sedimentation rate may be a helpful indicator for diagnosis. Regardless of surgery or nonsurgery, most patients achieved a favorable prognosis.
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Affiliation(s)
- Wei-Ran Hu
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zi-Long Yao
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Yu
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Nan Jiang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Saglam F, Saglam S, Gulabi D, Eceviz E, Elmali N, Yilmaz M. Bilateral clavicle osteomyelitis: A case report. Int J Surg Case Rep 2014; 5:932-5. [PMID: 25460439 PMCID: PMC4275825 DOI: 10.1016/j.ijscr.2014.10.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 10/13/2014] [Accepted: 10/13/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Osteomyelitis of the clavicle is rare. Infection occurs from hematogenous spread or trauma. In adults infection is usually secondary due to an exogenous cause such as open fractures, surgery (iatrogenic) or spread from local tissue with infection. PRESENTATION OF CASE The case is presented here of a 50-year old female with bilateral clavicular fractures, who was operated on with open reduction and internal fixation. At the 6-month follow-up, she had complaints of bilateral osteomyelitis which was successfully treated with resection of the infected segment of the bone, and antibiotic impregnated collagen. DISCUSSION Predisposing factors include diabetes, intravenous drug abuse, tuberculosis or immune suppression. Management involves the removal of bone fixation, debridement of the bone and if there is a defect, coverage with a muscle flap is applied. CONCLUSION In cases of clavicular osteomyelitis where infection continues despite debridement and antibiotic therapy, excision of the sequestered clavicular section is a successful treatment approach and has been seen to improve quality of life without any functional loss.
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Affiliation(s)
- Fevzi Saglam
- Dr. Lütfi Kırdar Kartal Training and Research Hospital, Kartal, İstanbul 34890, Turkey.
| | - Seymanur Saglam
- Infectious Diseases and Clinical Microbiology, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Kartal, İstanbul 34890, Turkey.
| | - Deniz Gulabi
- Dr. Lütfi Kırdar Kartal Training and Research Hospital, Kartal, İstanbul 34890, Turkey.
| | - Engin Eceviz
- Dr. Lütfi Kırdar Kartal Training and Research Hospital, Kartal, İstanbul 34890, Turkey.
| | - Nurzat Elmali
- Dr. Lütfi Kırdar Kartal Training and Research Hospital, Kartal, İstanbul 34890, Turkey.
| | - Mustafa Yilmaz
- Infectious Diseases and Clinical Microbiology, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Kartal, İstanbul 34890, Turkey.
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Sugi MT, Fedenko AN, Menendez LR, Allison DC. Clavicular eosinophilic granuloma causing adult shoulder pain. Rare Tumors 2013; 5:e8. [PMID: 23772307 PMCID: PMC3682460 DOI: 10.4081/rt.2013.e8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 09/17/2012] [Accepted: 10/03/2012] [Indexed: 11/23/2022] Open
Abstract
Though rarely reported, neoplasms of the clavicle occur, and their symptoms can be mistaken for more common shoulder conditions. We present the case of a benign clavicular neoplasm, rarely seen in adults, presenting with pain, and eventual pathologic fracture in a 49 year-old. A 49 year-old male firefighter underwent arthroscopic rotator cuff repair for shoulder pain after magnetic resonance imaging revealed supraspinatus tendon tear. The patient's pain persisted after surgery, and was described as routine until he developed severe pain after minor blunt trauma. A local Emergency Room performed the first x-rays, which revealed a pathologic fracture of the distal clavicle through a destructive lesion. The patient was referred to an orthopedic oncologist, who performed incisional biopsy, which initially diagnosed osteomyelitis. The patient was subsequently taken to surgery for debridement. Pathology then yielded the diagnosis of eosinophilic granuloma. The patient was taken back to surgery for formal curettage with open reduction and internal fixation. The patient's pain resolved, the pathologic fracture fully healed, and the patient returned to full time work as a firefighter. Though workup for common shoulder conditions often identifies incidental benign lesions of bone, the converse can be true. Persistent pain despite intervention should raise concern for further investigation. An x-ray alone can reveal a destructive bone lesion as the source of shoulder pain.
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Affiliation(s)
- Michelle T Sugi
- Department of Orthopedic Surgery, University of Southern California Keck Medical Center, Los Angeles, CA
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Balakrishnan C, Vashi C, Jackson O, Hess J. Post-traumatic osteomyelitis of the clavicle: A case report and review of literature. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2008; 16:89-91. [PMID: 19554172 PMCID: PMC2691560 DOI: 10.1177/229255030801600208] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Osteomyelitis of the clavicle is a rare form of infection occurring from hematogenous spread or trauma. This has been reported following head and neck surgery, and subclavian catheter placement. In traumatic cases, the management involves removal of bone fixation, debridement of the bone and coverage with a muscle flap.
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Affiliation(s)
| | - Christopher Vashi
- Department of Plastic Surgery, Wayne State University, Detroit, Michigan, USA
| | - Ollie Jackson
- Department of Plastic Surgery, Wayne State University, Detroit, Michigan, USA
| | - Jason Hess
- Department of Plastic Surgery, Wayne State University, Detroit, Michigan, USA
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Hickman Catheter-Associated Nosocomial Staphylococcus aureus Scapular Osteomyelitis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2007. [DOI: 10.1097/01.idc.0000269917.25595.3a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Venepuncture of the superficial veins in the forearm is considered a relatively safe procedure. We report two patients who presented with osteomyelitis of the proximal radius following venous cannulation of the median cubital vein, and one patient who developed osteomyelitis of the distal radius after cannulation of the cephalic vein. Osteomyelitis developing in proximity to a venepuncture site should raise the suspicion that a pathogen causing superficial thrombophlebitis has spread through the deep veins of the arm into the adjacent bone, thus causing osteomyelitis.
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Affiliation(s)
- R Straussberg
- Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tikva, Israel 49202.
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Corso FA, Shaul DB, Wolfe BM. Spinal osteomyelitis after TPN catheter-induced septicemia. JPEN J Parenter Enteral Nutr 1995; 19:291-5. [PMID: 8523628 DOI: 10.1177/0148607195019004291] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Osteomyelitis of the spine is a well-recognized delayed manifestation of septicemia but has not been recognized as a complication of total parenteral nutrition. We report five cases of spinal osteomyelitis that were clinically recognized 1 to 13 months after total parenteral nutrition catheter-induced septicemia. Radiographic evidence of osteomyelitis was seen in all five patients. In three patients, culture of bony aspirates was positive for the same organism as from the blood. In one case, the diagnosis was established by histology, and in one the diagnosis was based on radiographic and radionuclide evidence of osteomyelitis. The organism responsible was Staphylococcus aureus in two cases, Candida albicans in another two cases and C tropicalis in one case. The septic episode that preceded osteomyelitis was treated with systemic antibiotics and catheter removal in four patients, and antibiotics without catheter removal in one patient. Nevertheless, osteomyelitis occurred, requiring bracing or operative debridement as well as prolonged antibiotic therapy. Spinal osteomyelitis may occur as a delayed manifestation of total parenteral nutrition catheter-induced septicemia. Prompt and effective treatment of septicemia is indicated but may not always be sufficient. Clinical suspicion is the key to the correct and early diagnosis of osteomyelitis and therefore to adequate treatment.
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Affiliation(s)
- F A Corso
- Department of Surgery, University of California, Davis, USA
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Aglas F, Gretler J, Rainer F, Krejs GJ. Sternoclavicular septic arthritis: a rare but serious complication of subclavian venous catheterization. Clin Rheumatol 1994; 13:507-12. [PMID: 7835020 DOI: 10.1007/bf02242953] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Sternoclavicular septic arthritis is a rare complication of subclavian venous catheterization. We estimate that septic involvement of this joint may be as common as one in 500 catheterizations. We report two patients with insidious onset of shoulder pain, chest discomfort, low-grade fever and slight but painful swelling of a sternoclavicular joint four weeks following subclavian venous catheterization. Positive blood cultures in the presence of abnormal bone scan and abnormal conventional X-ray examination or computed tomography of the sternoclavicular joint led to the diagnosis of septic arthritis. Both patients responded well to antibiotic treatment. Based on our observations and that reported in the literature, the earliest changes of sternoclavicular septic arthritis may be detected by bone scan while plain X-ray studies and CT become abnormal during advanced stages of this type of arthritis. We would like to alert physicians to this cause of fever and joint pain in patients who previously underwent subclavian venous catheterization.
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Affiliation(s)
- F Aglas
- Department of Internal Medicine, Karl Franzens University, Graz, Austria
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Chen WS, Wan YL, Lui CC, Lee TY, Wang KC. Extrapleural abscess secondary to infection of the sternoclavicular joint. Report of two cases. J Bone Joint Surg Am 1993; 75:1835-9. [PMID: 8258556 DOI: 10.2106/00004623-199312000-00015] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- W S Chen
- Department of Orthopedic Surgery, Chang-Gung Memorial Hospital, Kaohsiung, Taiwan
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Abstract
Osteomyelitis in uncommon locations can present unusual diagnostic difficulties. A patient with primary sternal osteomyelitis who presented with pain over the right supraclavicular area and a radiologic picture of a pleural-based right upper lung mass is discussed. A triple-phase bone scan was consistent with the diagnosis, and a needle aspiration of the mass revealed a staphylococcal abscess. Percutaneous drainage of the contiguous abscess and a prolonged course of antibiotic therapy cured the infection.
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Affiliation(s)
- W K Lo
- Department of Medical Specialties, University of Texas M. D. Anderson Cancer Center, Houston
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Abstract
A patient receiving home parenteral nutrition developed osteomyelitis of the clavicle associated with a Hickman catheter which had been functioning for 14 months. The infection was treated with bone curettage, parenteral antibiotics, and catheter removal. Although this has been a reported complication of subclavian vein catheters, this is the first reported case associated with a Hickman catheter.
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Affiliation(s)
- A B Kravitz
- Department of Surgery, Medical Center of Delaware, Newark
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13
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Klein B, Mittelman M, Katz R, Djaldetti M. Osteomyelitis of the clavicle as complication of infected subclavian vein catheter. Am J Med 1987; 83:1006. [PMID: 3674082 DOI: 10.1016/0002-9343(87)90675-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
Six cases with chronic inflammatory hyperostotic and sclerotic changes of the clavicle are reported. No causative organisms could be detected. Four patients had involvement of other bones including the thoracic spine, the femur, the tibia and the sternal end of the other clavicle. These may be classified as having "chronic recurrent multifocal osteomyelitis" (CRMO). The remaining two patients with similar clavicular changes might have an, as yet, unifocal CRMO.
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Finestone HM, Graor RA, Jaynes PK, Sarkar TK, Gumaste VV. Editor's Mail. Postgrad Med 1985. [DOI: 10.1080/00325481.1985.11698837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lindsey RW, Leach JA. Sternoclavicular osteomyelitis and pyoarthrosis as a complication of subclavian vein catheterization: a case report and review of the literature. Orthopedics 1984; 7:1017-22. [PMID: 24823247 DOI: 10.3928/0147-7447-19840601-18] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Numerous complications have been attributed to subclavian vein catheterization. Osteomyelitis and/or sternoclavicular pyoarthrosis is a rarely mentioned complication, previously reported only four times. Soft tissue infections occur frequently and respond well to topical and antibiotic treatment. If symptoms should persist for several weeks, osteomyelitis and/or sternoclavicular pyoarthrosis should be considered. We advocate management with early surgical intervention. Bone and gallium scans are helpful diagnostically, but CT scans offer the best assessment of the sternoclavicular joint itself. Surgery has produced excellent results, without functional compromise.
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