Abstract
Posttraumatic sternoclavicular arthritis related to chronic ligamentous instability after posterior sternoclavicular dislocation represents a rare but challenging problem. The current article in the Journal’s “Safe Surgical Technique” series describes a successful salvage procedure by partial resection of the medial clavicle and ligamentous reconstruction of the sternoclavicular joint with a figure-of-eight semitendinosus allograft interposition arthroplasty.
Highlights
Since the first description of a traumatic posterior sternoclavicular dislocation 170 years ago [1], several anecdotal case reports have been published on this rare injury pattern [2,3,4,5,6,7,8]
Aside from the risk of a vascular injury [11], tracheal tears and esophageal compression have been described, which lead to acute dyspnea and dysphagia [12]
Establishing an early diagnosis is difficult since these injuries are frequently missed [5,15,16]
Summary
Since the first description of a traumatic posterior sternoclavicular dislocation 170 years ago [1], several anecdotal case reports have been published on this rare injury pattern [2,3,4,5,6,7,8]. A follow-up CT scan at 9 months post injury revealed significant posttraumatic arthritis of the left sternoclavicular joint, in conjunction with recurrent posterior subluxation of the medial clavicle (Figure 7). The surgical plan entailed a partial resection arthroplasty of the medial clavicle in conjunction with a ligamentous reconstruction with a semitendinosus allograft tendon woven in a figure-of-eight pattern through drill holes in the manubrium and residual medial clavicle This particular technique has been shown to improve stability compared to local tissue transfers, e.g. using the ‘classic’ Burrows technique [30], and has been associated with excellent subjective outcomes in cases of chronic pain and posttraumatic joint instability [43]. He was able to resume full activity without restrictions within one month after the surgical revision procedure
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