Successful Manubriosternal Fusion Following Failure of Open Reduction and Internal Fixation of a Traumatic Manubriosternal Dislocation

Abstract

Manubriosternal joint dislocations are rare clinical entities that may occur secondary to trauma1-4, inflammatory arthropathy5-7, or infection8. When they occur in a traumatic setting, concomitant cardiac contusions, pulmonary contusions, and spine fractures or dislocations may be observed9,10, and they must be treated appropriately. Manubriosternal dislocations may be classified as type-1 injuries, in which the sternal body is dislocated posteriorly with respect to the manubrium, or as type-2 injuries, in which the sternal body is dislocated anteriorly11. It is felt that most posterior dislocations are the result of direct impact to the anterior chest wall, while anterior dislocations are uniformly the result of an indirect flexion-compression mechanism12. Both operative1-4 and nonoperative8,10,11,13 strategies have been employed, but because of the relative rarity of this injury, a consensus regarding optimal management has not been established. To our knowledge, few reports of this injury exist in the literature, and we are unaware of any cases of operative fixation that have required revision surgery. We report the failure of an open reduction and internal fixation (ORIF) of a type-2 dislocation, which was salvaged with a successful manubriosternal fusion. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A fifty-year-old woman presented to the emergency department after a fall from an all-terrain vehicle onto her anterior chest wall. She had a history of posterior spinal fusion for scoliosis thirty-seven years prior to presentation, but was otherwise healthy. Chief symptoms were anterior chest pain and midthoracic back pain. On physical examination, she had an obvious sternal deformity with associated tenderness and was tender throughout the mid-to-lower thoracic region posteriorly. Radiographs …