Ipsilateral sternoclavicular joint dislocation and fracture of the medial end of the clavicle

Abstract

A 30-year-old male on holiday abroad, fell from hismountainbikewhilsttravellingatspeed,injuringhisright shoulder. Admission radiographs confirmed thepresence of a medial clavicular fracture and he wastreated conservatively using a broad arm sling(Fig. 1).Three weeks later, on his return from holiday,further radiographs were taken due to ongoing painand swelling. In addition to the fracture, a disloca-tion of the sternoclavicular joint was identified. Acomputedtomography (CT) scan of theSCJs demon-strated lateral displacement of the right clavicleandassociatedfracturesofthetransverseprocessofthe first thoracic vertebra and the first rib (Fig. 2).The senior author elected to stabilise the clavicularfracture and the SCJ surgically.Due to the small size of the medial fracturefragment and the need to reconstruct the SCJ,the clavicular fracture was fixed using a six-holesmall fragment reconstruction plate. This gave suf-ficient space for the SCJ to be stabilised using a freepalmaris longus graft harvested from the patient’sipsilateralarm.Thegraft wastakenthroughaseriesof small stab incisions, and fed through holes madein the medial end of the clavicle and the anteriortable of the manubrium. The graft was secured in afigure of eight configuration using absorbablesutures, in effect reconstructing the anterior jointcapsule (Fig. 3).The patient was discharged from hospital thefollowing day and his shoulder was immobilised ina broad arm sling for 6 weeks. Thereafter he wasencouraged to gently mobilise his shoulder and by 3months following the procedure he had regained asymptom free full range of movement. At this stagehe was permitted to carry loads in his right handwithout restriction (Fig. 4).