Surgical management of sternoclavicular joint infection

Arab, Walid Abu; Khadragui, Ibrahim; Échavé, Vincent; Deshaies, Annie; Sirois, Chantal; Sirois, Marco

doi:10.1016/j.ejcts.2010.12.037

Cited by 19 publications

(40 citation statements)

References 25 publications

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“…The authors therefore recommend joint resection if any of the following factors are noticed during the pre-operative diagnostic workup: signs of bony destruction, chest wall phlegmon or abscess, retrosternal abscess, mediastinitis or pleural spread [14]. Abu Arab et al used five grades of infection based on clinical and radiological criteria and derived from them a graduated algorithm for the therapeutic management of septic arthritis of the SCJ [7]. Using this grading system, Jang et al treated 22 patients with septic arthritis of the SCJ caused by staphylococcus aureus.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Innovative Surgical Concept for Septic Sternoclavicular Arthritis: Case Presentation of a Simultaneous Joint Resection and Stabilization with Gracilis Tendon Graft Including Literature Review

et al. 2020

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Introduction Septic arthritis of the sternoclavicular joint (SCJ) is a rarity in everyday surgical practice with 0.5 – 1% of all joint infections. Although there are several risk factors for the occurrence of this disease, also healthy people can sometimes be affected. The clinical appearance is very variable and ranges from unspecific symptoms such as local indolent swelling, redness or restricted movement of the affected shoulder girdle to serious consequences (mediastinitis, sepsis, jugular vein thrombosis). Together with the low incidence and the unfamiliarity of the disease among practicing doctors in other specialties, this often results in a delay in the diagnosis, which in addition to a significant reduction in the quality of life can also have devastating consequences for the patient. Patient and Method According to a stage-dependent procedure, the therapy strategies range from antibiotic administration only to radical resection of the SC joint and other affected structures of the chest wall in severe cases with the following necessity for flap reconstruction. The aspect of possible post-interventional instability after resection of the SCJ receives little or no attention in the current literature. In the present case report of a 51-year-old, otherwise healthy gentleman with isolated monoarthritis of the right SCJ with Escherichia coli (E. coli) shortly after two prostatitis episodes, the possibility of a new surgical approach with a one-stage eradication and simultaneous stabilization of the SCJ is presented. Therefore, a joint resection including extensive debridement is performed while leaving the posterior joint capsule and inserting an antibiotic carrier. In the same procedure, the SCJ is then stabilized with an autologous gracilis tendon graft by using the “figure of eight” technique, which has become well established particularly for anterior instabilities of the SCJ in recent years. Results and Conclusion One year after operative therapy, the patient presented symptom-free with an excellent clinical result (SSV 90%, CS89 points, CSM 94 points, TF 11 points, DASH 2.5 points). It is concluded that in selected cases with an infection restricted to the SCJ without major abscessing in the surrounding soft tissues, the demonstrated procedure leads to good and excellent clinical results with stability of the joint. If the focus of infection and germ are known, stabilization using an autologous graft can be carried out under antibiotic shielding. To the best of the authorsʼ knowledge, this surgical procedure has not yet been described in the current literature. Depending on the extent of the resection, an accompanying stabilization of the SCJ should be considered to achieve stable conditions and an optimal clinical outcome.

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Section: Discussion and Literature Reviewmentioning

confidence: 99%

Innovative Surgical Concept for Septic Sternoclavicular Arthritis: Case Presentation of a Simultaneous Joint Resection and Stabilization with Gracilis Tendon Graft Including Literature Review

et al. 2020

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“…The closure of the wound after resection of the sternoclavicular joint infection seems to favor using myocutaneous flaps, as evidenced by the stronger studies [ 1 , 5 , 6 , 22 ]. The use of myocutaneous flap can help obliterate the dead space resulting from resection of the sternoclavicular joint.…”

Section: Reviewmentioning

confidence: 99%

“…As shown in Figure 1, most of the original articles on the surgical management of sternoclavicular joint infections came from the United States (11, 68%) [1,3,5,6,[12][13][14][15][16][17][18]. Two studies came from Asia (12.5%) [4,19], one was from Europe (6.25%) [20], and two were multi-national [21,22].…”

Section: Origins Of Included Articlesmentioning

confidence: 99%

The Preferred Treatment of Sternoclavicular Joint Infections: A Systematic Review

Ali

Barlas

Shetty

et al. 2020

Cureus

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The treatment of sternoclavicular joint infection is a topic of controversy. This systematic review aims to evaluate the preferred treatment of sternoclavicular joint infections. A literature search using PubMed/MEDLINE®/Embase databases was conducted to identify publications on the surgical management of sternoclavicular joint infections. Case reports and studies without surgical management were excluded. The outcomes of interest included patient demographics, comorbidities, infectious etiologies, radiographic features, surgical management, and complications. Sixteen articles met the inclusion criteria. The mean age of the subjects was 53.4 years; there was a predominance of males (65%), and a minority of the subjects were obese (15%). The most common infectious etiology was methicillin-susceptible Staphylococcus aureus (MSSA) (48%). CT scan was reported in 46% of cases. The most common treatment was surgical resection of the joints (85%), followed by muscle flap closure of the wounds (54.2%). The complication rate ranged from 0-40%. Specifically, recurrence of infection was low with resection of the joint, followed by muscle flap closure. Given the heterogeneity of the methodology and inconsistency in the outcomes, a meta-analysis could not be performed. Overall, the current literature favors the resection of the sternoclavicular joint as the gold standard treatment. Closure of the wound using muscle flap seems to adequately treat this problem without any major untoward events.

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“…In this study, patients with an elevated BMI may have been found to have worsened infections during operative exploration, necessitating a deferral to multiple operations in order to achieve adequate infection clearance and definitive closure. As mentioned, immunosuppression and chronic disease states are associated with SCJ infection [ 8 , 14 ]. We hypothesize that an elevated BMI may predispose a similar state and influence worsened infection in the context of SC osteomyelitis.…”

Section: Discussionmentioning

confidence: 99%

A multi-institutional analysis of sternoclavicular joint coverage following osteomyelitis

et al. 2020

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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/m2. 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/m2 vs. 32.9±9.1 kg/m2; 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.

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Surgical management of sternoclavicular joint infection

Cited by 19 publications

References 25 publications

Innovative Surgical Concept for Septic Sternoclavicular Arthritis: Case Presentation of a Simultaneous Joint Resection and Stabilization with Gracilis Tendon Graft Including Literature Review

Innovative Surgical Concept for Septic Sternoclavicular Arthritis: Case Presentation of a Simultaneous Joint Resection and Stabilization with Gracilis Tendon Graft Including Literature Review

The Preferred Treatment of Sternoclavicular Joint Infections: A Systematic Review

A multi-institutional analysis of sternoclavicular joint coverage following osteomyelitis

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