Posterior Sternoclavicular Joint Injuries in Skeletally Immature Patients

Abstract

The management of sternoclavicular injuries in skeletally immature patients has not been well described. The purpose of this study was to describe the authors' experience treating this rare and potentially life-threatening injury. All skeletally immature patients who underwent treatment for a medial clavicular physeal fracture or sternoclavicular dislocation between 2003 and 2011 were identified using ICD-9 diagnostic codes. Sternoclavicular injuries with posterior displacement were isolated from this cohort for a thorough chart review. Patients were contacted to complete brief phone surveys and shoulder-specific outcome instruments. A total of 12 boys (mean age, 14.8±2.74 years), followed for an average of 10.3 months (range, 0-54 months), were identified. The incidence of significant associated symptoms was 8.3% (1 of 12). Eight patients were initially treated with closed reduction, 2 (25%) successfully and 6 (75%) requiring subsequent open reduction. Four of the 12 patients underwent an immediate open reduction. Braided composite sutures were used to treat all injuries that underwent open reduction (10 of 12). Complete data were obtained from 6 patients, all of whose injuries had been treated with open reduction. All 6 had returned to their full activity level, and all self-reported perfect Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Simple Shoulder Test scores (0 and 12, respectively). Among skeletally immature patients, medial clavicular physeal fractures and sternoclavicular dislocations can be effectively managed with closed or open reduction. When closed reduction is unsuccessful or is contraindicated, open reduction with braided composite sutures is associated with excellent results.

Posterior Sternoclavicular Joint Injuries in the Adolescent Population

“…25,29 We selected 48 hours as the cutoff for defining a delayed presentation based on its common use in previous studies as well as the authors' experience. 33 Closed reductions performed within 48 hours were successful 55.8% (43/77) of the time, while closed reductions performed 48 hours after the injury were successful only 30.8% (4/13) of the time. Far more patients who underwent closed treatment did so within 48 hours of injury (n = 77) as compared with the number of patients who underwent closed treatment 48 hours after the initial injury (n = 13).…”

“…Of the patients with 1-year follow-up, 29 patients in 5 case reports/series 1,19,33,36,37 were evaluated using functional Complications are associated with the initial injury. Complication-related information was not available for 2 patients.…”

Successful repair of thoracic outlet syndrome in a growing young patient due to posterior sternoclavicular joint dislocation

“…Dislocation of the sternoclavicular joint is very rare and is never seen by many surgeons, especially the posterior subtype (2-4). However, because of the anatomical proximity of the structures in superior mediastinum and thoracic outlet, including the great vessels, esophagus, trachea and lungs, and brachial plexus, posterior sternoclavicular dislocations are potentially fatal (1,3,4). Systematic and swift evaluation is mandatory for proper management of these patients (3).…”

“…Posterior sternoclavicular dislocation is an extremely rare injury, usually related to heavy trauma, such as a traffic accident (1,2). The anatomical proximity of vital mediastinal structures can complicate closed reduction, especially during emergency situations (1,3,4).…”

“…Posterior sternoclavicular dislocation is an extremely rare injury, usually related to heavy trauma, such as a traffic accident (1,2). The anatomical proximity of vital mediastinal structures can complicate closed reduction, especially during emergency situations (1,3,4). We present a rare case, in which an emergent open reduction using both sutures reduction and simultaneous plate stabilization of a posterior sternoclavicular dislocation was performed for thoracic outlet syndrome due to compression of great vessels and nerves.…”