Masquerading as a fracture: Congenital pseudoarthrosis of the clavicle

Congenital pseudoarthrosis of the clavicle (CPC) is a rare developmental entity characterized by nonunion of the medial and lateral ossification centres of the clavicle, most often involving the right side. This typically manifests at birth or early childhood as a painless midclavicular prominence with minimal functional impairment but can be mistaken radiographically for a fracture. Here, we report a case of CPC in a female infant born at 41 weeks of gestation to a primigravida mother. Delivery was complicated by shoulder dystocia requiring McRoberts and Rubin's manoeuvres. On the first day of life, the right shoulder demonstrated limited abduction, tenderness, and weakness, with a palpable gap over the right mid-clavicle. Radiographs demonstrated a well-corticated, bulbous defect between the medial and lateral segments of the clavicle, consistent with CPC. This case highlights the importance of differentiating CPC from a birth-related fracture (sharp margins and callus formation on follow-up imaging) to avoid unnecessary workup or intervention.