Condensing osteitis of the clavicle in children

Table 1 Patient demographics

Patient	Age (yr)	Side	Gender	Symptoms	Biopsy	Antibiotic 1	Antibiotic 2	Evolution	Complications
1	10.5	Right	Male	Pain and discomfort in the sterno-clavicular joint Swelling	Yes	Teicoplanin Rifampin 8 wk		Remission	-
2	11.2	Right	Male	Pain and discomfort in the sterno-clavicular joint Swelling	Yes	Teicoplanic Amoxicillin/clavulanic acid 17 d	Rifampin Trimethoprim-sulfamethoxazole 13 d	Remission	-
3	11.2	Right	Male	Pain and discomfort in the sterno-clavicular joint Swelling	Yes	Teicoplanic Amoxicillin/clavulanic acid 17 d	Rifampin Trimethoprim-sulfamethoxazole 13 d	Remission	-
4	12.1	Right	Female	Pain and discomfort in the sterno-clavicular joint Swelling	Yes	Teicoplanic Amoxicillin/clavulanic acid 17 d	Rifampin Trimethoprim-sulfamethoxazole 13 d	Remission	-
5	12.4	Right	Male	Pain and discomfort in the sterno-clavicular joint Swelling	Yes	Teicoplanin Rifampin 8 wk		Remission	-
6	11.5	Right	Female	Swelling	Yes	Teicoplanin Amoxicillin/clavulanic acid 13 d	Azitromycin 5 d Rifampin Amoxicillin/clavulanic acid 10 wk	Remission	Adverse effect with Teicoplanin
7	13	Right	Male	Swelling	Yes	Teicoplanic Amoxicillin/clavulanic acid 17 d	Rifampin Trimethoprim-sulfamethoxazole 13 d	Recurrence of pain	-

Table 2 Review of the literature

Ref.	Number of cases	Symptoms
Brower et al[1]	1	Pain
Teates et al[12]	2
Simpson[3,5-7,10]	1	Limited ROM
Duro[3,5-7,10]	2
Appell et al[2]	7
Weiner[3,5,10]	1	Pain
Franquet[3,5,10]	2	Pain (related to work)
Cone[3,5,10]	1	Pain (worsening)
Kruger et al[7]	3	Pain (mild to moderate)
Outwater et al[10]	1	Limited ROM
Stewart[3,5,10]	1	Pain (intermittent)
Jones et al[6]	3	Pain
Lissens et al[8]	2
Greenspan et al[4]	3
Vierboom et al[13]	1	Pain (worsening)
Latifi[3,5-7,10]	1
Tait[3,5-7,10]	1
Berthelot et al[3]	2
Hsu et al[5]	1
Rand et al[14]	4	Pain (intermittent) Discomfort in the sterno-clavicular joint
Noonan et al[9]	1	Pain (chronic)
Sng et al[11]	9	Pain Discomfort in the sterno-clavicular joint
Imran[3,5-7,10]	1 (bilateral)
Present study (2016)	7	Pain Discomfort in the sterno-clavicular joint
Total	58 patients (59 clavicles)

ROM: Range of movement.

Table 3 Differential diagnosis

Disease	Clinical and/or radiological features
Osteoarthritis	Narrowed joint space with marginal osteophytes, sclerosis restricted to the sub-chondral bone on both sides of the joint
Infection	Bone destruction, synovial abnormality, joint space narrowing, and periosteal reaction
Chronic, sclerosing osteomyelitis	Dense sclerosis similar to condensing osteitis of the clavicle, but periosteal reaction and/or foci of bone destruction
Osteoblastic lesion	Different age at onset, shorter duration of symptoms, epiphyseal location is atypical, periosteal reaction ± bony destruction, progression on serial studies
Metastases	As a solitary bone scan abnormalities in the clavicle epiphysis (unusual)
Osteoid osteoma	Classic central lucent nidus
Sternoclavicular hyperostosis	Usually bilateral, ossification of sterno-clavicular ligaments, bone scan abnormalities at sternum superior ribs, spinal ligamentous ossification and sacro-iliac abnormalities, systemic and specific dermatologic manifestations (palmoplantar pustulosis)
Friedreich’s disease	Shorter duration of symptoms, clearer relationship to trauma, bone scan similar, X-rays similar ± subchondral irregularity and focal lucencies, biopsy: Osteonecrosis is typical (but marrow fibrosis or osteonecrosis have been described in several cases of condensing osteitis of the clavicle)
Tietze’s syndrome	Involvement of one or more costal cartilages, the clavicle is not involved on radiographs or scan
Chronic recurrent multifocal osteomyelitis	The lesion is initially lytic and with healing, sclerotic and expansile, involves the middle two thirds sparing the medial end, and is typically at presentation. Inflammatory process can be seen at histological examination
Paget’s disease	Greater area involved, and the bone scan dramatically more abnormal, localizations in other bones, elevated level of alkaline phosphatase occurs in adults