Anterior Sternoclavicular Joint Dislocation Research Articles

Delayed Presentation of Traumatic anterior Sternoclavicular Joint Dislocation - A Case Report and Literature Review

Abstract: Traumatic sternoclavicular joint dislocations are uncommon, accounting for just 1% of all documented upper limb dislocations, despite the fact that upper limb dislocations are very common literature offers only a handful of documented instances of such dislocations. Among them, anterior dislocations are more frequently observed than posterior dislocations, owing to the robust ligamentous support in this area. We describe the case of a 35-year-old male patient who had isolated anterior sternoclavicular dislocation and a successful reduction procedure used on him. The rarity of such cases is emphasized by the satisfactory outcomes presented in our report.

Is reconstructing anterior sternoclavicular joint dislocation by a high-strength tape suture a good choice?

Objectives: Sternoclavicular joint (SCJ) dislocation is uncommon but dangerous. Redislocation frequently occurs after manual reduction due to the torn ligaments of the joint with a high-energy injury, which is often the case. Reconstruction of the SCJ is recommended to avoid poor efficacy of conservative treatment and decreasing quality of life in the patient due to progressive pain limiting the movement of the shoulder girdle. Our study aimed to evaluate the efficacy, safety, and patient satisfaction using a high-strength non-absorbable tape suture to reconstruct the anterior SCJ dislocation. Methods: This study included ten patients (Nine males and one female) who presented with acute anterior dislocation of the SCJ (six on the right and four on the left side). Our patients’ average age was 40.1 years (18–52 years), with 12 months on average follow-up (9–18 months). Four patients had isolated anterior SCJ dislocation, while the others had associated injuries. Results: All patients had excellent functional and satisfactory outcomes and returned to the pre-injury activity level. No intraoperative or major post-operative complications were recorded, and no injuries to near structures or wound problems were noted. The mean improvement of physical function measured by the American shoulder and elbow score was 24.59, which increased from 68.11 ± 3.72 preoperatively to 92.70 ± 3.54 postoperatively. Conclusion: The technique of open reconstruction of anterior SCJ dislocation using high-strength nonabsorbable tape sutures is recommended because it gave us excellent results regarding the safety, functional outcome, patient satisfaction, and avoidance of other surgical site morbidities.

Operative treatment outcomes of anterior sternoclavicular joint dislocation using two experimental methods - an acromioclavicular joint hook plate versus a locking plate: a retrospective study

BackgroundWe aimed to compare the intraoperative and early postoperative clinical outcomes of using an acromioclavicular joint hook plate (AJHP) versus a locking plate (LP) in the treatment of anterior sternoclavicular joint dislocation.MethodsSeventeen patients with anterior sternoclavicular joint dislocation were retrospectively analyzed from May 2014 to September 2019. Six patients were surgically treated with an AJHP, and 11 were surgically treated with an LP. Five male and one female patients composed the AJHP group, and nine male and two female patients composed the LP group. The mean age of all patients was 49.5 years.ResultsReduction and fixation were performed with AJHP or LP in all 17 patients. The mean operative blood loss, operative time, and length of incision in the AJHP group were significantly better than those in the LP group. Shoulder girdle movement of the AJHP group was significantly better than that of the LP group.ConclusionsThis study revealed that AJHP facilitated glenohumeral joint motion, reduced the risk of rupture of mediastinal structures, required a shorter incision, and had lesser blood loss and a shorter duration of operation compared with LP. However, some deficiencies require further improvement.

Anterior dislocation of sternoclavicular joint: A novel surgical technique

IntroductionAnterior sternoclavicular joint dislocation (SCJ) is a relative rare injury, related to high energy trauma. The objective of the present study is to present a novel suture technique for treatment of anterior SCJ traumatic dislocation and to report clinical outcomes from a small case series undergoing this procedure. Patients and MethodsPatients presenting with traumatic anterior SCJ disruption in our institution were eligible to participate. Surgical technique consisted of two bone tunnels drilled in vertical direction from the anterior to the posterior cortex of the manubrium. Analogous to the sternal side of the clavicle, two vertical bone tunnels were drilled from the anterior cortex towards the posterior cortex. A non-absorbable suture was passed though the four holes in a parallel configuration. Then, by pulling the free suture edges the posterior translation of the clavicle was performed. Two additional drill holes, the first in manubrium and the second in clavicle were performed from the anterior cortex to the posterior between the previous bone tunnels. A non-absorbable suture was placed in a simple configuration in order to stabilize the SCJ in the superior–inferior direction. The final follow up was 28.2 months. The mean QuickDASH was used for functional assessment. ResultsSeven patients (6 males and 1 female) with average age of 34,8 years were included in the present study. Two patients suffered from concomitant medial clavicle fracture. At final follow-up (none of the patients had experienced any symptoms of instability of SCJ, no side-to-side difference was observed, while the Mean QuickDASH score was 4.85. ConclusionThe reported technique for SCJ reconstruction in traumatic anterior SCJ dislocations with two sutures has theoretical advantages, since it stabilizes the SCJ in the antero–posterior, as well as the supero- inferior direction. Outcomes from this small case series are favorable. However, more research is desirable to compare different techniques and to conclude to the optimal surgical treatment.

One Case of Anterior Dislocation of Sternoclavicular Joint Treated by Sternoclavicular Hook Plate

One Case of Anterior Dislocation of Sternoclavicular Joint Treated by Sternoclavicular Hook Plate

Treatment of traumatic anterior dislocation of sternoclavicular joint with allogeneic tendon of "W" type knit

To investigate effectiveness of allogeneic tendon of "W" type knit in repair of traumatic anterior dislocation of sternoclavicular joint. Between June 2013 and June 2017, 12 patients with traumatic anterior dislocation of sternoclavicular joint after poor conservative treatment were treated with allogeneic tendon of "W" type knit. Of them, 10 were males and 2 were females, aged from 25 to 58 years (mean, 42 years). All injuries were caused by traffic accidents. The time from injury to operation was 4-12 weeks (median, 6 weeks). All of them were closed injuries. The patients had no fracture around the shoulder, or blood vessels, nerves, and other adjacent limb joint injuries. The operation time, intraoperative blood loss, incision healing, and complications were recorded. The sternoclavicular joint was observed by X-ray film and CT at 1 year after operation. Visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, Rockwood score, modified Hospital for Special Surgery (HSS) score, and Constant-Murley score were used to evaluate the function of shoulder joint after operation. The operation time was 60-80 minutes (mean, 70 minutes). The intraoperative blood loss was 50-100 mL (mean, 60 mL). Primary healing of incision was obtained in all patients without complications. All the patients were followed up 12-24 months (mean, 18 months). At 1 year after operation, X-ray film and CT examination showed that the position of sternoclavicular joint was satisfactory. At 1 year after operation, the Rockwood score was 12-14 (mean, 13). The UCLA score was 28-34 (mean, 31). The VAS score was significant lower than that before operation ( P<0.05), and the Constant-Murley score and modified HSS score were significantly higher than those before operation ( P<0.05). The repair of traumatic anterior dislocationr of sternoclavicula joint with allogeneic tendon of "W" type knit can effectively reconstruct the stability of the joint, retain the physiological fretting, and obtain satisfactory results.

Treatment of Anterior Sternoclavicular Joint Dislocation with Acromioclavicular Joint Hook Plate

ObjectiveTo evaluate the safety and efficacy of using acromioclavicular joint hook plates for the treatment of anterior sternoclavicular joint dislocation.MethodsTen patients who suffered anterior sternoclavicular joint dislocation were retrospectively analyzed, and underwent acromioclavicular joint hook plate surgeries from January 2015 to May 2017. There were 7 male and 3 female patients, with a mean age of 43.6 years. According to the American Shoulder and Elbow Society (ASES) scoring system, the preoperative physical function had a mean of 83.5.ResultsReduction and fixation were performed with hook plates in all 10 patients. All patients were followed up, with a mean duration of 16.9 months. There were no complications, no wound infections, and no plate or screw breakages. Movement of the shoulder girdle was improved in all patients. According to the ASES scoring system, the postoperative physical function had a mean of 94.8.ConclusionThe acromioclavicular joint hook plate demonstrates safety and efficacy for the treatment of anterior sternoclavicular joint dislocation. However, there are still some deficiencies that need to be improved.

A New Frontier for the Medial Clavicle

HISTORY: A 63 year-old male presented with a 2-week history of left upper extremity pain after being hit by a car on his left side while riding his bicycle. He sustained fractured ribs, an extraarticular fracture-dislocation of the left medial clavicle, a minimally displaced oblique fractured left scapular body, and a displaced, comminuted fractured left distal radius for which he underwent ORIF. While hospitalized, he was informed there were no surgical options to treat his left clavicle fracture-dislocation. PHYSICAL EXAMINATION: Examination revealed a male with his left arm in a sling. He had a prominent anterior sternoclavicular joint and deformity of his medial clavicle. His range of motion was limited due to pain and guarding. He had 2+ radial pulses, intact sensation to light touch, and no obvious motor dysfunction of his upper extremities. DIFFERENTIAL DIAGNOSIS: 1. Anterior sternoclavicular joint dislocation 2. Medial clavicular fracture-dislocation TESTS AND RESULTS: Left shoulder CT scan: 1. Comminuted, anteriorly angulated fracture of the medial aspect of the left clavicle with severe shortening and subluxation of sternoclavicular joint. 2. Minimally displaced oblique fracture through scapular body. Multiple anterior and posterior ribs. No pneumothorax. FINAL DIAGNOSIS: 1. Medial clavicular fracture with significant shortening and fracture-dislocation of sternoclavicular joint. 2. Minimally displaced scapular body fracture. 3. Anterior and posterior rib fractures. TREATMENT AND OUTCOMES: He underwent an ORIF of his medial clavicle fracture-dislocation using a 7-hole 15-mm hook plate. The plate was placed under the inferior border of the medial head of the clavicle and superior to the first rib to push the lateral clavicle fragment posteriorly to reduce the fracture. Screws were placed in the hook plate to stabilize the fracture and maintain the clavicle out to length as much as possible. The arm was ranged with mild motion of the hook plate under the sternum and the fracture stable. His scapular and rib fractures were treated nonoperatively. A hook plate is designed for fixation of a lateral clavicle fracture, but its use in medial clavicle fractures has not been well established. We offer this case as an example of a successful outcome using this novel operative approach.

A rare case of anterior sternoclavicular joint dislocation with clavicle fracture with subclavian artery thrombosis

Sternoclavicular (SC) joint injuries are rare. These usually follow violent injuries or high-velocity trauma events. These injuries can be either anterior or posterior dislocations. Anterior dislocations may be left alone, but posterior dislocations could cause complication by compressing the posterior structures including major vessels, airway esophagus, and larynx. We report a 17-year-old boy who fell from his two-wheeler sideways and injured his left shoulder. He presented to the emergency department with an open fracture of the clavicle. A detailed evaluation revealed an associated anterior SC joint dislocation, and there was an injury to the subclavian artery. The patient was planned for an emergency surgery, and the clavicle fracture was fixed following thrombectomy of the subclavian artery. The patient was successfully treated and had a good functional range of movement of his shoulder at 1 year follow-up. Anterior SC joint dislocations with concomitant open clavicle fracture are an unusual injury pattern. We report a complex injury pattern of the clavicle associated with traumatic vascular injury. We report this case for its complexity and the technical challenge it poses to the treating surgeons.

Bilateral Asymmetrical Traumatic Sternoclavicular Joint Dislocations = خلع رضحي ثنائي الجانب لا متناظر للمفصل القصي الترقوي

Unilateral and bilateral sternoclavicular joint (SCJ) dislocations are rare injuries. The difficulty in assessing this condition often leads to delay in diagnosis and treatment. We report a rare case of bilateral asymmetrical traumatic SCJ dislocations in a 45-year-old male. The right anterior SCJ dislocation was reduced in the emergency room (ER) and resulted in residual instability. The left posterior SCJ dislocation was asymptomatic and unnoticed for six months. It is important for ER physicians and orthopaedic surgeons to be able identify and treat this condition. All suspected SCJ dislocations should be evaluated by computed tomography (CT) scan for confirmation of the diagnosis and evaluation of both SCJs. Posterior SCJ dislocation is a potentially fatal injury and should not be overlooked due to the presence of other injuries. Surgical intervention is often necessary in acute and old cases.

Reconstruction for anterior sternoclavicular joint dislocation and instability

Sternoclavicular joint (SCJ) instability is relatively rare. Surgical treatment may be considered for severely displaced dislocations or symptomatic recurrent anterior instability. The purpose of this study was to describe an SCJ ligament reconstruction technique and retrospectively evaluate its safety and effectiveness for treating anterior SCJ dislocations and instability. A retrospective review of demographics, medical history, injury characteristics, and pretreatment pain and functional levels was performed. A soft-tissue graft woven in a Roman numeral X pattern through clavicular and sternum subcortical bone tunnels was used. Patients were evaluated with postoperative visual analog scale (VAS) and functional scores, and their ability to return to normal preoperative sports and activities was determined. Six patients were evaluated with a mean follow-up of 40 months (range, 24.5-58 months). Injury mechanisms included acute trauma (3 patients), minor trauma (1 patient), and chronic atraumatic instability (2 patients). The mean preoperative symptom duration was 11 months (range, 0.5-27.5 months). Autograft hamstring graft was used in all cases with no resulting surgical complications. All 6 patients had full range of motion with no instability after treatment. Five patients had no pain (0 of 10 on VAS), whereas one patient had mild pain (1 to 3 of 10 on VAS). All 6 patients had improved functional scores.All returned to preoperative activities and participation in sports. No recurrent instability occurred. In 1 case, failure occurred at 4 years with recurrent pain, and revision was performed. The results of our study indicate that reconstruction for anterior SCJ dislocation is safe with results comparable to previously described surgical stabilization techniques. This technique provides a surgical treatment option for symptomatic anterior SCJ dislocation and instability.

Sternoclavicular hook plating for traumatic anterior sternoclavicular joint dislocation

Objective To investigate the clinical outcomes of sternoclavicular hook plate in treatment of the anterior sternoclavicular joint dislocation. Methods A new device named sternoclavicular hook plate was devised by our team. Between May 2002 and Octorber 2009, 66 patients with sternoclavicular joint anterior dislocation were treated with the new device, among whom there were 47 males and 19 females,aged 21-68 years old (average, 32.6 years old). Twenty-one cases were caused by crush injury, 5 cases by falling and 40 cases by traffic accident. Anterior fracture-dislocation was found in 41 cases. According to the Allman system, there were 35 cases of type Ⅱ and 31 cases of type Ⅲ. Patients were evaluated with serial clinical and radiographic examinations. Rockwood score were used after the operation to assess the curative effect. Results The average operative time was 33 min (range, 20-48 min). The mean blood loss was 60 ml (range, 20-90 ml). There were no vascular or peripheral nerve injuries in the patients. All incisions healed smoothly. The X-ray and CT showed that the reduction of sternoclavicular joint and the location of internal fixation were satisfactory. All the 66 patients were followed up for 12-37 months (average, 17 months). There was no internal fixation failure, redislocation or other complications. The sternoclavicular hook plate was removed 12 months after operation. The mean Rockwood's score was 13.2 (8 to 15). There were excellent in 50cases, good in 15 cases, and fair in 1 case. Conclusion The sternoclavicular hook plate is a new, safe and liable technique for sternoclavicular fracture-dislocation. This new technique is helpful for early functional exercises. Key words: Sternoclavicular joint; Dislocations; Bone plates; Fracture fixation,internal

Sterno clavicular joint dislocation: a case report of a surgical stabilization technique

Sterno Clavicular Joint (SCJ) dislocations are rare injuries of the shoulder girdle. Their management is controversial due to a not guaranteed outcome after any kind of treatment (conservative or open). Open reduction is challenging because of the anatomical site, while the conservative treatment does not always improve pain or instability discomfort. We report a case of traumatic and painful anterior SCJ dislocation of a young policewoman treated with open reduction by a new surgical technique. Functional result is extremely good at 2 years of follow-up.

Treatment of traumatic anterior sternoclavicular joint dislocation with Fastin anchors

Objective To discuss the treatment of traumatic anterior sternoclavicular joint disloca-tion with Fastin anchors. Methods A retrospective analysis was done for 14 patients with traumatic anterior sternoclavicular joint dislocation who had been treated with Fastin anchors from March 2006 to April 2008. They were 9 males and 5 females, with an average age of 35 years (range, 21 to 46 years) . Their diagnoses were confirmed by X-ray and CT scan. After reduction and temporary Kirschner wire fixation of the sternoclavicular joint, the anchor was driven into the manubrium sterni, with the suture at the end of the anchor securely knotted after passing through the internal extremity of clavicle. The Kirschner wire was re-moved after 3 weeks. Results All the patients were followed up for 12 to 22 months (average, 17 months). The results were excellent in 11, good in 3 according to Rockwood scale. There was no loss of re-duction or implant loosening. Conclusion Fastin anchor can fix the sternoclavicular joint reliably, avoiding potential risk of Kirschner wire migration and ensuring fine functional recovery of the joint. Key words: Sternoclavieular joint; Suture anchors; Wounds and injuries; Dislocation