Sternoclavicular joint purulent arthritis and its complications: tactics of surgical treatment, results of restoration

Abstract

Aim: to improve the treatment and diagnostic tactics in patients with sternoclavicular joint purulent arthritis. Materials and methods. A prospective, single-center study was conducted which included 30 patients with acute purulent arthritis of the sternoclavicular joint and its complications. Patients were divided into 2 groups based on the operative technique: the main – 20 patients who were operated following the proposed surgical tactics, and the control – 10 patients. Results. The cause of sternoclavicular joint purulent inflammation, clavicle and rib osteomyelitis was a hematogenous dissemination of microbial infection with concomitant diseases in most cases (n = 22; 73.3 %). The criteria for the short-term treatment results assessment such as the surgery duration, total blood loss, termination of exudation and removal of drainage tubes, length of hospital stay, the dynamics of changes in the inflammatory response markers did not differ significantly between the groups. The dynamics of pain syndrome according to VAS did not differ on the second day 66.5 (65.0; 67.0) versus 64.5 (61.0; 69.0), P = 0.201). Similar result was obtained on day 5: 49.5 (47.5; 54.0) versus 53.5 (51.0; 54.0), P = 0.314. However, pain was significantly reduced in the main group on the 10th postoperative day 27.0 (23.5; 30.0) versus 37.5 (34.0; 39.0), P = 0.005. A much more restoration of the movement amplitude and better functional outcomes on the QuickDASH scale were obtained in the main group (P = 0.017). Conclusions. Diagnosis of sternoclavicular joint purulent arthritis includes an analysis of the clinical picture of the disease and the results of radiologic imaging. Active surgical tactics and anatomically determined choice of the clavicle resection site provide good short-term results. The introduced comprehensive approach to the diagnosis and surgical treatment of sternoclavicular joint purulent arthritis facilitate obtaining better functional outcomes in comparison with traditional multi-stage tactics.