Treatment of Sternoclavicular Joint Osteomyelitis with Debridement and Delayed Resection with Muscle Flap Coverage Improves Outcomes

Abstract

The objective of this study was to evaluate the efficacy of various treatment options for sternoclavicular joint osteomyelitis. We evaluated patients with a diagnosis of sternoclavicular joint osteomyelitis, treated at our hospital from 2002 to 2012. Four treatment options were compared. Three out of twelve patients were successfully cured with antibiotics alone (25%). Debridement with or without negative pressure therapy was successful for one of three patients (33%). Simultaneous debridement, bone resection, and muscle flap coverage of the acquired defect successfully treated one of two patients (50%). Debridement with delayed bone resection and muscle flap coverage was successful in five of five patients (100%). Osteomyelitis of the sternoclavicular joint is a rare disease that has become more prevalent in recent years and can be associated with increasing use of long-term indwelling catheters. Initial debridement with delayed bone resection and pectoralis major muscle flap coverage can effectively treat sternoclavicular joint osteomyelitis.

Extended sternoclavicular joint infections in cirrhotic patients: staged interdisciplinary approach with thoracic and plastic surgery

“…In our opinion, the adequate assessment of the bone viability and the osteomyelitis extent is of key relevance in the treatment of SCJ infections. The postponed bone resection thanks to NPT allows to better assess the bone viability and to define the resection extent, particularly in severe infections [13] .…”

“…For the complete filling of the residual space, protective coverage of the exposed brachiocephalic vessels and preservation of neurovascular integrity in the upper extremity the pectoral muscle has commonly been accepted [11] . Some authors provided the vascularized muscle flap an additional anti-inflammatory effect due to the direct antibiotic delivery to the infection site once the flap is in place [13] . The novel technique of the large bone defect obliteration with engineered bone tissue is a challenge in the reconstructive surgery [14] .…”

Sternoclavicular Osteomyelitis in an Immunosuppressed Patient: A Case Report and Review of the Literature

“…In this case, findings on imaging suggested osteomyelitis. A 7×2.5 cm abscess was present anterior to the SCJ, which is frequently seen in SCJ osteomyelitis [ 1 ]. Additionally, a bone scan revealed increased uptake, consistent with osteomyelitis.…”

“…Sternoclavicular osteomyelitis is a rare disease, with less than 250 cases identified in the past 50 years [ 1 ]. Conditions that suppress the immune system can increase the risk of developing this disease.…”

Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies

“…Aspiration with antibiotics with or without debridement in early cases can be curative. 74 , 78 , 91 , 92 However, when radiographic evidence of infection beyond the sternoclavicular joint is present, incision and drainage with resection of the medial clavicle or en bloc resection with grafting or interposition arthroplasty may be needed. 73 , 74 , 92 , 93 These may need to be staged procedures after debridement.…”