sternoclavicular hyperostosis with pathological fracture of the clavicle—a case report

CORRESPONDENCE Letter to the Editor Sternoclavicular hyperostosis with pathological fracture of the clavicle–—a case report $ I read the above case report with interest published in Raja et al. 1 I would like to ask authors the following. 1. Is there any evidence to suggest that hyperostosis reduces the biomechanical strength of bone so as to cause the fracture? 2. At what stage of healing was the biopsy taken? 3. Did her symptoms disappear after the fracture healing? Reference 1. Raja S, Goel A, Paul A. Sternoclavicular hyperostosis with pathological fracture of the clavicle–—a case report. Injury 2003;34:464—6. D. Mittal 2 Lawrence Close, Norden, Rochdale Lancs OL12 7PJ, UK Corresponding author. Tel.: þ44-1706-342813 E-mail address: [email protected] 14 August 2003 doi:10.1016/j.injury.2003.10.011 Authors’ Reply Sternoclavicular hyperostosis with pathological fracture of the clavicle–—a case report $ The following is our reply to the reader’s com- ments. We thank Mr. Mittal for his letter. 1 We are not aware of any biomechanical studies in sternoclavicular hyperostosis however, studies in dominant endosteal hyperostosis have shown increased stiff- ness of bone. 2 Circumstantial evidence suggests that sclerotic bone is brittle and therefore may predispose to fracture. 3 Biopsies were taken in the early healing phase and the patient’s symptoms improved significantly following fracture healing. Reference 1. Mittal D. Sternoclavicular hyperostosis with pathological fracture of the clavicle–—a case report. Injury 2004;35: 635. 2. Beals RK, Mcloughlin SW, Teed RL, Mcdonald C. Dominant endosteal hyperostosis. J Bone Joint Surg Am 2001;83: 1643—9. 3. Redden JF, Dixon J, Venmart W, Hoskins DJ. Management of fissure fracture in Paget’s disease. Int Orthop 1981;5: 103—6. S. Raja A. Goel A. Paul * University Department of Orthopaedic Surgery Manchester Royal Infirmary Oxford Road, Manchester M13 9WL UK * Tel.: þ44-161-276-4818 fax: þ44-161-276-8006 18 September 2003 doi:10.1016/j.injury.2003.10.012 Injury, Int. J. Care Injured (2004) 35, 634 $ PII of original article S0020-1383(02)00259-0. $ doi of original article 10.1016/j.injury.2003.10.011. 0020–1383/$ — see front matter ß 2003 Elsevier Ltd. All rights reserved.

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$Page 1: Sternoclavicular hyperostosis with pathological fracture of the clavicle—a case report$

CORRESPONDENCE

Letter to the EditorSternoclavicular hyperostosis with pathologicalfracture of the clavicle–—a case report

I read theabovecasereportwith interestpublished inRaja et al.1 I would like to ask authors the following.

1. Is there any evidence to suggest that hyperos-tosis reduces the biomechanical strength ofbone so as to cause the fracture?

2. At what stage of healing was the biopsy taken?3. Did her symptoms disappear after the fracture

healing?

Reference

1. Raja S, Goel A, Paul A. Sternoclavicular hyperostosis withpathological fracture of the clavicle–—a case report. Injury2003;34:464—6.

D. Mittal2 Lawrence Close, Norden, Rochdale

Lancs OL12 7PJ, UKCorresponding author. Tel.: þ44-1706-342813

E-mail address: [email protected] August 2003

doi:10.1016/j.injury.2003.10.011

Authors’ ReplySternoclavicular hyperostosis with pathologicalfracture of the clavicle–—a case report

The following is our reply to the reader’s com-ments.

We thank Mr. Mittal for his letter.1 We are notaware of any biomechanical studies in sternocla-vicular hyperostosis however, studies in dominantendosteal hyperostosis have shown increased stiff-ness of bone.2 Circumstantial evidence suggeststhat sclerotic bone is brittle and therefore maypredispose to fracture.3 Biopsies were taken inthe early healing phase and the patient’s symp-toms improved significantly following fracturehealing.

Reference

1. Mittal D. Sternoclavicular hyperostosis with pathologicalfracture of the clavicle–—a case report. Injury 2004;35:635.

2. Beals RK, Mcloughlin SW, Teed RL, Mcdonald C. Dominantendosteal hyperostosis. J Bone Joint Surg Am 2001;83:1643—9.

3. Redden JF, Dixon J, Venmart W, Hoskins DJ. Managementof fissure fracture in Paget’s disease. Int Orthop 1981;5:103—6.

S. RajaA. GoelA. Paul*

University Department of Orthopaedic SurgeryManchester Royal Infirmary

Oxford Road, Manchester M13 9WLUK

*Tel.: þ44-161-276-4818fax: þ44-161-276-8006

18 September 2003

doi:10.1016/j.injury.2003.10.012

Injury, Int. J. Care Injured (2004) 35, 634

$PII of original article S0020-1383(02)00259-0.$doi of original article 10.1016/j.injury.2003.10.011.