Medial Epiphyseal Fracture-detachment of the Sternoclavicular Joint with Posterior Displacement in a Judo Athlete – equivalent of Posterior Sternoclavicular Dislocation

Abstract

Posterior sternoclavicular dislocation is a rare traumatic injury that presents a potential risk of injury to mediastinal structures. The diagnosis is fundamentally clinical and treatment is done on an emergency basis. The authors report the clinical case of a young judo athlete with post-traumatic medial epiphyseal fracture-detachment, with posterior displacement (lesion equivalent to posterior sternoclavicular dislocation at pediatric ages). He underwent open reduction and ligament repair by means of a mini-anchor. The radiological and clinical outcome was excellent, and the athlete returned to his sports activity without limitations. We discuss the particular features of this pathological condition, along with the different therapeutic approaches and their complications.

Innominate artery pseudoaneurysm from a Salter-Harris fracture of the sternoclavicular joint

“…Posterior dislocations are less common but are more serious due to potential compression and injury to mediastinal structures such as the subclavian artery, innominate artery, internal jugular vein, and trachea. 5 Approximately 30% of patients with posterior SCJ injuries could have injuries to these mediastinal structures. 9 , 10 Patients with posterior SCJ injuries often present with pain in the affected shoulder, with radiation to the neck, 11 swelling, paresthesia, neurologic deficits, and hoarseness or dyspnea if tracheal compression occurs.…”

“…The epiphysis at the medial portion of the clavicle is the last to complete its ossification, fusing with the shaft of the clavicle at 23 to 25 years. 5 Consequently, younger patients are, overall, more susceptible to epiphyseal Salter-Harris I or II fracture-dislocations rather than a true dislocation. 5 , 13 In fact, the Salter-Harris classification is specifically a method used to grade fractures in children that involve the growth plate, with five grades describing the exact involvement of the physis, metaphysis, and epiphysis.…”

“… 5 Consequently, younger patients are, overall, more susceptible to epiphyseal Salter-Harris I or II fracture-dislocations rather than a true dislocation. 5 , 13 In fact, the Salter-Harris classification is specifically a method used to grade fractures in children that involve the growth plate, with five grades describing the exact involvement of the physis, metaphysis, and epiphysis. 14 The clinical presentation can often mimic a ligamentous injury.…”

“…Several methods for SCJ reconstruction are described in the literature, including soft tissue reconstruction with a tendon graft, plate fixation, and the use of suture anchors. 4 , 5 The use of Kirschner wires or Steinman pins for stabilization is not recommended due to the risk of migration to vital structures. 4 Many repair techniques require anterior to posterior drilling at the clavicle and manubrium, posing the risk of injury to posterior vascular structures.…”

“… 4 However, an accurate diagnosis is crucial because (1) closed reductions are often insufficient to treat the physeal fracture; and (2) posterior displacement, when it does occur, requires investigation of potential concomitant injuries to mediastinal structures such as the great vessels, brachial plexus, and trachea. 5 …”