Malignant lesions are rare in medial third of the clavicle in children: the European Juvenile Medial End of Clavicle Tumour study

Condensing osteitis is a condition presenting to all paediatric orthopaedic services, but the prevalence of the condition and optimal management is difficult to determine from the literature. Many case reports in the orthopaedic literature describe biopsy to exclude malignancy as mandatory, whereas expert radiological opinion has suggested that lesions can be classified as typical of sclerosing osteitis on imaging alone. The aim of this study was to calculate an accurate incidence of malignancy at the medial end of the clavicle in children based on data held by national and regional cancer registries in Europe. In addition, this study determined the published success of biopsy in identifying a causative organism. The investigators wrote to 173 European national or regional cancer registries requesting the number of malignant lesions at the medial end of the clavicle in those less than 19 years of age, how long the registry had been in existence and the size of the population served. A literature review was conducted of Medline and Pubmed using the terms, 'condensing osteitis,' 'chronic recurrent multiostotic osteomyelitis,' 'acute osteomyelitis,' 'chronic osteomyelitis clavicle,' 'sclerosing osteitis' and 'sclerosing osteomyelitis' and refined to those regarding the clavicle. The incidence of malignancy at the medial end of the clavicle was found to be extremely low (one case every 275 child-years at risk). In addition, biopsy rarely identified a causative organism with only two of 89 biopsies being positive. We suggest that for a chronic nonmalignant process in which clinical features are typical, serial imaging with follow-up is sufficient although timely biopsy would be recommended when doubt exists.