A multi-institutional analysis of sternoclavicular joint coverage following osteomyelitis

Abstract

Background Sternoclavicular joint (SCJ) osteomyelitis is a rare pathology requiring urgent intervention. Several operative approaches have been described with conflicting reports. Here, we present a multi-institutional study utilizing multiple surgical pathways for SCJ reconstruction.Methods A multi-institutional retrospective cohort study was conducted to identify patients who underwent surgical repair for sternoclavicular osteomyelitis between 2008 and 2019. Patients were stratified according to reconstruction approach: single-stage reconstruction with advancement flap and delayed-reconstruction with flap following initial debridement. Demographics, operative approach, type of reconstruction, and postoperative outcomes were analyzed.Results Thirty-two patients were identified. Mean patient age was 56.2±13.8 years and 68.8% were male. The average body mass index (BMI) was 30.0±8.8 kg/m<sup>2</sup>. The most common infection etiologies were intravenous drug use and bacteremia (both 25%). Fourteen patients (43.8%) underwent one-stage reconstruction and 18 (56.2%) underwent delayed twostaged reconstruction. Both single and delayed-stage groups had comparable rates of reinfection (7.1% vs. 11.1%, respectively), surgical site complications (21.4% vs. 27.8%), readmissions (7.1% vs. 16.6%), and reoperations (7.1% vs. 5.6%; all P>0.05). The single-stage reconstruction group had a significantly lower BMI (26.2±5.7 kg/m<sup>2</sup> vs. 32.9±9.1 kg/m<sup>2</sup>; P<0.05) and trended towards shorter hospital length of stay (11.3 days vs. 17.9 days; P=0.01).Conclusions Both single and delayed-stage approaches are appropriate methods with comparable outcomes for reconstruction for SCJ osteomyelitis. When clinically indicated, a singlestage reconstruction approach may be preferable in order to avoid a second operation as associated with the delayed phase, and possibly shortening total hospital length of stay.

A method for eliminating a chest wall defect after the sternoclavicular joint resection

“…Объем вмешательства зависит от изменений ГКС и общего состояния пациента. В некоторых ситуациях можно ограничиться артротомией и дренированием сустава на фоне комплексной консервативной терапии [3,4]. В большинстве случаев для полного подавления воспаления приходится прибегать к удалению ГКС и обширным резекциям костных структур: ключицы/ключиц, грудины, ребра/ребер [5].…”