Hi!

I am a sports physio who has very little experience in paediatrics, and I have a one year old boy with a pseudarthrosis of his right clavicle. On X-ray it is clear that it is in two peices, with quite a large separation and overlap. He is unable to bear weight through his arm, and subsequently can not crawl or lift himself up from a prone position.

My question is what options are there to deal with this problem? Is this something that can be pinned like a normal clavicular fracture? If so, at what age would this be considered? If surgery is not an option then are there conservative options such as bracing available?

Some background: He has a chromosome disorder that has never been recorded in the literature - an unbalanced translocation between 11 and Y (a small piece of 11 has been duplicated onto the end of the Y chromosome). The consequences of this are that he has had cardiac surgery for atrial and ventricular septum defects and a PDA, and he has delayed motor and cognitive development. Obviously the clavicle problem is holding him back even further with the motor development, so I am desperate to improve that in any way I can.

Interestingly the only case in the literature that is similar (but a diffrent combination of chromosomes) to my son had several common features, including the cardiac defects. That child also had incompletely developed clavicles bilaterally. So I assume this is a congenital defect in my son, and not an un-united fracture from his birth.

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