Posterior dislocation of the sternoclavicular joint and epiphyseal disruption of the medial clavicle with posterior displacement in sports participants

Abstract

We retrospectively analysed the clinical results of 30 patients with injuries of the sternoclavicular joint at a minimum of 12 months' follow-up. A closed reduction was attempted in 14 cases. It was successful in only five of ten dislocations, and failed in all four epiphyseal disruptions. A total of 25 patients underwent surgical reduction, in 18 cases in conjunction with a stabilisation procedure. At a mean follow-up of 60 months, four patients were lost to follow-up. The functional results in the remainder were satisfactory, and 18 patients were able to resume their usual sports activity at the same level. There was no statistically significant difference between epiphyseal disruption and sternoclavicular dislocation (p > 0.05), but the functional scores (Simple Shoulder Test, Disability of Arm, Shoulder, Hand, and Constant scores) were better when an associated stabilisation procedure had been performed rather than reduction alone (p = 0.05, p = 0.04 and p = 0.07, respectively). We recommend meticulous pre-operative clinical assessment with CT scans. In sternoclavicular dislocation managed within the first 48 hours and with no sign of mediastinal complication, a closed reduction can be attempted, although this was unsuccessful in half of our cases. A control CT scan is mandatory. In all other cases, and particularly if epiphyseal disruption is suspected, we recommend open reduction with a stabilisation procedure by costaclavicular cerclage or tenodesis. The use of a Kirschner wire should be avoided.

Management and functional outcomes following sternoclavicular joint dislocation

“…Despite a relatively low incidence of intraoperative neurovascular incident, anatomical studies display the close proximity of mediastinal structures to the SCJ, highlighting the potential risk which may have devastating consequences [15]. The majority of studies in the literature recommend having a cardiothoracic surgeon available for any open reduction of a posteriorly dislocated SCJ [6,8,10,15,17,24].…”

“…Using the same mechanism, a younger patient (up to 25 years) may not sustain a true dislocation, rather a physeal disruption with clavicle displacement [4]. The presentation, potential complications and acute management in these cases are however the same as that which occurs with a true SCJ dislocation [3,8].…”

Radiologic Imaging of Chest Injuries

“…An anteriorly directed force to the sternomedial part of the clavicle can also give rise to a posterior (or retrosternal) dislocation, but this is not often the case (Buckley and Hayden 2008 ). Contact sports as American football (Brys and Geusens 2007 ), rugby (Brys and Geusens 2007 ;Laffosse et al 2010 ;Blakeley et al 2011 ), judo and wrestling (Laffosse et al 2010 ) and high-speed sports as motorcycling (Brys and Geusens 2007 ), skiing and equitation (Laffosse et al 2010 ) are most often the cause of sports-related posterior sternoclavicular joint dislocation (Brys and Geusens 2007 ).…”

Les luxations sternoclaviculaires traumatiques vues en urgence

“…On recherchera surtout des anomalies confirmant ou évoquant des complications associées : déviation trachéale, élargissement du médiastin, pneumothorax, hémotho-rax, emphysème sous-cutané et fractures de la clavicule et/ou des côtes. Plusieurs incidences spécifiques ont été décrites dans la littérature [9,10]. L'incidence de Heinig [11] est la plus connue, elle permet de voir un déplacement dans le plan horizontal [12].…”

“…Le délai de réduc-tion orthopédique d'une luxation rétrosternale par manoeuvres externes varie selon les auteurs entre 48 heures post-traumatiques et 10 jours [6,10]. En cas de luxation postérieure, il existe diffé-rentes techniques en abduction ou adduction avec traction sur le bras et pression d'avant en arrière sur l'épaule suivies d'une immobilisation [13].…”