Manubriosternale Luxation durch indirektes Stauchungstrauma

Abstract

Manubriosternal dislocation caused by indirect flexion-compression trauma is an extremely rare condition. Two forms of manubriosternal luxation are distinguished: in type I the sternum is dislocated posterior and in type II anterior to the manubrium. Direct or indirect trauma may cause manubriosternal dislocation. Mode of injury in direct trauma is mostly a head-on collition in a motor accident resulting either in type I or type II luxation. The unusual origin of manubriosternal dislocation by indirect trauma is put down to flexion-compression injuries of the thoracic spine and results in a type II dislocation. Predisposition to manubriosternal dislocation by indirect trauma consists in rheumatoid arthritis or extreme forms of kyphosis. Outcome of many patients treated conservatively after initial reposition with adhesive tape, symptomatic pain therapy, cryotherapy and prohibition of any physical training over several weeks is subluxation or complete luxation of the manubriosternal joint. This condition may lead to chronic pain, periarticular calcification with ankylosis and progredient deformation. Lacking a controlled study for treatment of manubriosternal dislocation a standard therapeutic regime could not be established yet. In the literature only a few case-reports of patients undergoing operative therapy are published. We report a type II dislocation of the manubriosternal joint caused by indirect flexion-compression trauma. We achieved a very good long-term result using a 8-hole 1/3 tubular plate for fixation of the manubriosternal joint after reposition.

Occult Manubriosternal Joint Injury Associated With Fracture of the Thoracic Spine

“…Traumatic lesion of the sternum can be produced by direct or indirect trauma. Direct force applied to the thorax can result in posterior luxation of the sternum on the manubrium, and traumas caused by car steering wheels are a particularly common cause of such injuries 5 , 11 .…”

“…The presence of associated lesions, such as fractures of the costal arches, vertebral spine or blood vessel lesions, may also lead to indications for surgical treatment. Due to the rarity of lesion, there is no standard surgical treatment, and fixation by means of cervical cerclage, thread sutures, fixation with Kirschner or Steinmann wire, osteosynthesis with plates, or the use of bioabsorbable materials were described 10 , 11 , 17 , 22 . We used fixation with two parallel plates and monocortical fixed-angle screws, inserted in the body of the sternum and manubrium, after open reduction of the manubriosternal joint.…”

Lesão oculta da articulação manúbrio-esternal associada à fratura da coluna torácica

“…Around 40%-70% of patients with rheumatoid arthritis may present this type of joint lesion due to weakening of the joint, chronic increase of thoracic kyphosis and consequent increase in forces transmitted from the first rib to the manubrium. The association of traumatic lesions of the sternum and fractures of the thoracic spine have been reported, particularly lesions caused by the flexion-compression or flexion-rotation mechanisms (10)(11)(12)(13) .…”

“…Due to the rarity of lesion, there is no standard surgical treatment, and fixation by means of cervical cerclage, thread sutures, fixation with Kirschner or Steinmann wire, osteosynthesis with plates, or the use of bioabsorbable materials were described (10,11,17,22) . We used fixation with two parallel plates and monocortical fixed-angle screws, inserted in the body of the sternum and manubrium, after open reduction of the manubriosternal joint.…”