Chronic Posterior Sternoclavicular Joint Fracture Dislocations in Children and Young Adults

Abstract

Posterior sternoclavicular joint (SCJ) fracture dislocations in children and young adults can be missed on initial examination or could fail closed treatment. We hypothesize that surgical interventions (open reduction and ligamentous reconstruction or medial clavicle resection depending on the clinical scenario) are safe treatment options in patients with symptomatic chronic posteriorly displaced SCJ injuries. A retrospective review was conducted of all patients younger than 25 years of age who underwent surgical treatment for chronic posteriorly displaced SCJ injuries at our institution from January 1, 1999 to December 31, 2011. Chronic injuries were defined as those presenting and/or treated at a minimum of 6 weeks from the causative injury. Indications for surgery included symptomatic posterior SCJ dislocations or posteriorly angulated physeal fractures that did not remodel and were refractory to nonoperative treatment. Subjective patient outcomes were obtained by mailed survey and telephone contact. Outcomes included a Disabilities of the Arm, Shoulder and Hand score, patient-rated levels of pain and/or disability, SCJ stability, and symptom improvement. Seven patients met the inclusion criteria and all patients reported postoperative improvement or complete resolution of pain at last clinical follow-up (mean, 13 mo). At average 5.5 years follow-up, all respondents (n=4) reported that their injury did not interfere with normal social activities or daily activities. No patients reported difficulty with employment; however, all patients reported mild difficulty with return to their level of athletic activity before SCJ fracture dislocation. Patients rated their level of pain or disability as 1.5 on a 10-point scale. Surgical intervention can reliably provide pain relief and facilitate successful return to activities including work in patients with symptomatic chronic posterior SCJ fracture dislocations. However, patients must be counseled that they may experience persistent symptoms with return to their previous level of sport performance. Therapeutic Study-Investigating the Results of Treatment: Level IV.