Clavicular osteomyelitis is a rare form of infection caused by hematogenous spread or trauma [1-3] Children below 5 years of age are particularly susceptible to hematogenous spread of acute osteomyelitis owing to their vascular metaphyseal ends. The objective of the management of clavicular osteomyelitis remains the elimination of infection with the help of debridement and intravenous antibiotics in order to prevent serious complications like sepsis, mediastinitis and haemorrhage from great vessels ^[4,5]. We present the first reported case in literature of complication in the form of complete clavicular resorption following debridement for osteomyelitis. Surprisingly, at 13-year follow-up, the patient has minimal functional deficit and is able to perform all his activities of daily living.

A 9-month-old infant presented to us with high-grade fever and pain in the region of the medial end of right clavicle (Fig. 1). Clinical examination revealed tenderness, swelling and discharging sinus over medial end of clavicle. Serological parameters and magnetic resonance imaging (MRI) were suggestive of medial clavicular osteomyelitis. The patient was operated on with incision, drainage of pus and wide local debridement for the osteomyelitis, and pus was sent for culture. The patient was given sensitive antibiotics for 6 weeks and the patient was kept on regular follow-up. There was complete resolution of infection at 6-week follow-up with no evidence of recurrence. The wound healed uneventfully and there was no clinical or serological evidence of infection. At sequential follow-ups of 1 and 5 years clavicle was not visualized (Fig. 2-4). At the latest 13-year follow-up, the patient has no evidence of right clavicle bone in comparison to the complete normal left clavicle (Fig. 5; 6a and b). But upon detailed clinical evaluation, the patient has no functional deficit (Fig. 7 and 8). He is able to attend school and carry out all his daily activities without any trouble whatsoever. Manual muscle testing grading showed near-normal power in all the muscle groups of the right upper limb. The DASH score in the right limb was 10 signifying better function. The grip strength of the right hand was not reduced as compared to the opposite normal side.

Hematogenous osteomyelitis of the clavicle is a rare entity with the incidence being around 1–3% ^[6,7]. Owing to the similarity of the clavicle to other membranous bones like ilium, osteomyelitis of clavicle is more difficult to treat than osteomyelitis of long bones ^[8]. The primary aim of management remains early diagnosis and prompt management with wide local debridement and appropriate sensitive intravenous antibiotics ^[1,9]. The known complications of clavicular osteomyelitis are sepsis, mediastinitis and hemorrhage from great vessels ^[10]. A rare and sparsely reported complication of osteomyelitis remains resorption of the bone. Bacterial infection of bone causes inflammatory bone loss that results from an imbalance between the increased activity of bone-resorbing osteoclasts, and a decrease in bone-forming osteoblasts ^[11]. In our case, it was noted at sequential follow-ups that the clavicle had not grown as much as the opposite side. There was definitive evidence of clavicular resorption at 1- and 5-year follow-ups. At sequential follow–up, the patient had no complaints of functional deficit. At final 13-year follow-up, we decided to go for a detailed evaluation of the status of the upper limb. Clinical examination revealed no functional deficit whatsoever. The patient has no difficulties in performing all the activities of daily living. He is able to attend school and play merrily. Objective evaluation with DASH score was around 10 pts (Range 0–150 with 0 being best function and 150 being poor function) and the grip strength by dynamometer showed no significant difference as compared to the normal opposite side. Upon imaging the X-ray, computed tomography and MRI revealed complete clavicular resorption. In this particular case, the patient has no clavicle at all! Yet he is able to perform all his activities smoothly and without any deficit.

This case highlights an unusual outcome of clavicle osteomyelitis, where a nearly complete resorption of the clavicle resulted in minimal functional deficit. It underscores the importance for clinicians to prioritize clinical recovery over radiological findings when assessing patient progress.

Clavicular osteomyelitis, though rare, can lead to significant bone loss, as seen in this case of near-total clavicular resorption. Despite this, early diagnosis, prompt debridement, and appropriate antibiotic therapy can result in favorable functional outcomes. This case underscores the importance of prioritizing clinical recovery over radiological findings in assessing long-term function. Clinicians should be aware that complete resorption of the clavicle may not necessarily lead to significant functional deficits, and patients may continue to lead normal lives with appropriate management and follow-up.