ISSN 0972-978X 

  About COAA








Chronic Osteomyelitis: An Unusual Localization For A Rare Form -Clavicle

C. Dieme, A. Sane, A. Dansokho, I. Keita, A. Ndiaye, S. Seye

*Orthopaedic – traumatology, A. Le Dantec  Hospital  Dakar Sénégal

Address for Correspondence

Dr Charles Dieme,
P O Box: 25.702 Dakar Sénégal.
Email :


The authors report a chronic case of osteomyelitis in its sequestering and sitting exteriorized form to the level of the clavicle.  This observation is original because of the scarcity of this form and the seat of the lesion.  The pathogenesis of osteomyelitis is pointed out.  The easy diagnosis is evoked, just as the absence of functional repercussion after sequestrectomy without minor surgical gesture.

J.Orthopaedics 2006;3(1)e8


Chronic osteomyelitis constitutes the result of the unfavourable evolution of the acute form.  It sits in general at the long bones and can cover several aspects.  But it is often characterized by an osseous sequestration at the origin of cutaneous fistula, acute alarm clocks and pathological fractures [ 2 ].  We describe the observation concerning a teenager who presents an exteriorized sequestering form, sitting on the level of the clavicle.

Case Report:

Mr. D. 16 years old consulted for an osseous projection exteriorized on the level of the average third of the right clavicle.  The examination showed that the projection developed with depends on the clavicle with an aspect on necroses osseous and a nauseant odor (fig. 1).  In addition, there was a cutaneous depression under the osseous projection with loss of not very significant substance.  The interrogation has revealed the appearance of a painful symptomatology for approximately 3 years with concept of a productive dent repeating during the evolution.  No modern treatment had been undertaken.  The radiography of the clavicle did not show a loss of osseous substance.  The osseous continuity of the clavicle was present with hypercondensation at the average third

(fig. 2).  Biological examinations:  numeration formulates blood, sedimentation test and C Reactive Protein were normal.  The search for an etiology tubercular patient and syphilitic was negative.  The chronic diagnosis of osteomyelitis of the clavicle in its exteriorized sequestering form was retained.  The ablation of the exteriorized sequestration was carried out easily without anaesthesia by means of a grip with sequestration.  The continuations were simple.  Cutaneous closing under the sequestration was carried out spontaneously.

Discussion :

Osteomyelitis gather all the infections of the bone and marrow by hematogen way.  The passage to the chronic form is the result of the unfavourable evolution of acute osteomyelitis [ 3 ].  Nevertheless, certain authors described chronic forms from the start [ 4,5 ].  However, the development made by Essadam made it possible to better include/understand pathogenesis [ 6 ].  It defines osteomyelitis as a process of devascularisation of the periosteal and endosteal arterial system secondary in 2 mechanisms of the infection:  the thrombophlébitis and the infection.  In the absence of an early diagnosis and an adapted treatment, the result of this process is necroses it bone.  This necroses can evolve to the resorption of the mortified zone or its detachment with constitution of sequestrations. 

The sequestrations of small size are generally included or  evacuated spontaneously by a cutaneous dent.  On the other hand, the sequestrations of big size generally require a surgical evacuation.  At our patient, exceptional fact, the sequestration was expressed in spite of its big size, making thus useless a surgical gesture (trepanation of the bone).  This exteriorisation of the sequestration is the consequence of a diagnostic delay and absence of an adapted treatment.  In the field of the localization, the osteomyelitis of the clavicle is rare [ 7 ].  It generally occurs by infection of vicinity after surgery of the head and the neck [ 8, 9 ].  Other modes of contamination of the clavicle were described after catheterization of the known vessels keyboards [ 10 ], [ 11 ], [ 12 ].  In our case, it east is about the unfavourable evolution of an acute osteomyelitis.  In the diagnostic plan, the osteomyelitis of the clavicle can make evoke the etiology tubercular patient, syphilitic.  But their research was unfruitful.  This affection can also enter within the framework of the SAPHO syndrome which associates a whole of ostéo-articular attacks cutaneous demonstrations [ 13, 14, 15 ].  In the forecast plan, no functional repercussion was noted at our patient.  The involucrum completely reconstituted the clavicle without any loss of osseous substance.  It is besides to recommend to carry out the ablation of the sequestration after a development proportional of the involucrum [ 16 ].

Reference :

  1. Badelon O., Bingen E., Broco J.L’ostéomyélite aigue des membres de l’enfant, Physiopathologie, diagnostic, évolution, pronostic, principes de traitement.Rev Prat 1991 ; 41 ; 450-458.

  2. Refass A., Elandaloussi M., Padovani JP et alLes ostéomyélites compliquées. In : les infections ostéo-articulaires. Monographie du groupe d’étude en orthopédie pédiatrique.Montpellier : Sauramps Médical, 1995 : 117-128.

  3. Maroteaux P.Les maladies osseuses de l’enfant. Flammarion, 1995, 3ème édition, 483-495.

  4. Castaing J.Ostéomyélite chroniqueE.M.C. App locomoteur 1963, 14 015C, 1-10.

  5. Schumaecher H., May T.E.M.C. Maladie infectieuse, 1998, 8-003-A-40, 1-4.

  6. Essaddam H., Hammon A.OstéomyélitesEncycl Med Chir, Elsevier, ParisRadiodiagnostic – Neuroradiologie – Appareil locomoteur, 31-218-B10, 1998, 18 p.

  7. Alessi D.M., Sercarz J.A., Calcaterra T.C.Osteomyelits of the clavicleArch Otolaryngol Head Neck Surg, 1998, 114, 9 : 1000-1002

  8. Granick M.S., Ramasastoy S.S., Goodman M.A., Hardesty R.Chronic osteomyelits of the clavicle.Plast Reconst Surg, 1989; 84 (1) : 80-84.

  9. Winslow C.P., Meyers A.A.Clavicular osteomyelitis as a complication of head and neck surgery.Ann Otol Rhinol Laryngol. 1998; 107 (8) : 720-725.


This is a peer reviewed paper 

Please cite as : C. Dieme:Chronic Osteomyelitis: An Unusual Localization For A Rare Form -Clavicle

J.Orthopaedics 2006;3(1)e8





Arthrocon 2011

Refresher Course in Hip Arthroplasty

13th March,  2011

At Malabar Palace,
Calicut, Kerala, India

Download Registration Form

For Details
Dr Anwar Marthya,
Ph:+91 9961303044



Powered by



© Copyright of articles belongs to the respective authors unless otherwise specified.Verbatim copying, redistribution and storage of this article permitted provided no restrictions are imposed on the access and a hyperlink to the original article in Journal of Orthopaedics maintained. All opinion stated are exclusively that of the author(s).
Journal of Orthopaedics upholds the policy of Open Access to Scientific literature.