Surgical treatment of osteochondroma on the first rib by double clavicle osteotomy and internal fixation with a reconstruction plate: A case report and literature review

INTRODUCTION: The accepted indication for surgical removal of osteochondroma is when a lesion becomes symptomatic. There have been no established standard surgical approaches to remove osteochondroma on the first rib and no report on management after that. This report aims to present a novel approach by double clavicle osteotomy followed with internal fixation. CASE PRESENTATION: A 17-year-old female presented with a gradually enlarged bony mass with tenderness at the supraclavicular area. Radiographic images revealed a bony mass attached to the first rib. The provisional diagnosis is osteochondroma. The tumor was approached by osteotomy at the proximal and distal shaft of the clavicle. After removing the entire tumor, the direct reduction and internal fixation of the clavicle were performed. DISCUSSION: Both, size of the mass and mobilization of the clavicle are factors in determining the surgical approach. Clavicular osteotomy, especially two sites, is considered when the lesion is extremely large. A possible complication after the clavicular osteotomy is nonunion or malunion. A proper technique of reduction and method of fixation contributes to reducing complications. CONCLUSION: The double clavicle osteotomy is an effective route for removing a large tumor at the first rib. Plate fixation following clavicular osteotomy contributes to bone union and excellent functional outcomes postoperatively.