Anterior Sternoclavicular Dislocation Caused by Indirect Compression Trauma

Abstract

Anterior dislocation of the sternoclavicular joint is extremely rare because the ligamentous connections surrounding the joint are strong. Since there is a very low complication rate, conservative treatment can be justified in most cases. Nonetheless, lack of reduction or, in case of re-dislocation, conservative treatment, is often associated with cosmetic asymmetry of the sternoclavicular joints due to ventral protrusion of the medial end of the clavicle. Furthermore, chronic pain, periarticular calcifications with ankylosis and progressive deformity may result. In cases of unsuccessful closed reduction and/or repeated re-dislocations despite corrective bandages, open reduction and fixation is indicated. An optimal, standardized operative procedure has not yet been established because of the small number of cases. The applied procedures include wire osteosynthesis, plate osteosynthesis, pin fixation with resorbable materials, complex capsular ligament reconstructions with displacement of tendons, resection of the medial end of the clavicle and arthrodesis of the sternoclavicular joint. We report about a patient who sustained an anterior dislocation of the sternoclavicular joint as a result of a road traffic accident. Initially, conservative treatment was implemented with closed reduction and a correction bandage. After repeated re-dislocation, despite the bandage, we decided to stabilize the reduction surgically using PDS cord for fixation in a transosseous tension band technique which aligned the anteriorly dislocated medial end of the clavicle with the sternal articulating surface. 1 year after operation, the patient is symptom-free. She is very satisfied with the cosmetic result. No further dislocation has occurred.