Posterior Sternoclavicular Joint Research Articles

Incidence of Intraoperative Cardiothoracic Intervention During Open Surgery Following Acute Posterior Sternoclavicular Joint Injury: A Case Series and Review of the Literature.

Acute posterior sternoclavicular joint injuries are rare but potentially lethal injuries-signs of mediastinal compression range from nonspecific to neurovascular compromise. Currently, orthopaedic experts recommend a cardiothoracic surgeon be placed on standby during open surgery for potential intraoperative complications. However, few studies have reported on how often cardiothoracic intervention is required. First, we identified patients in our institution by CPT codes 23530, 23525, and 23532 from January 1, 2002 to May 1, 2023. Demographic variables and intraoperative cardiothoracic intervention rates were collected. Second, we systematically reviewed the literature to identify articles on acute posterior sternoclavicular injury using PubMed, Embase, and CINAHL databases (through August 20, 2023). Exclusion criteria included conservative treatment, successful closed reduction, chronic injury (>6wk) cadaver studies, reviews, and nonavailable text. Thirteen local patients underwent open surgery for an acute posterior sternoclavicular joint injury, 11 males and 2 females with an average age of 18.2 years old (range: 15 to 32.4). The most common mechanism of injury was sports (n=9; 69.2%). Four (30.8%) patients had physical or radiographic evidence of mediastinal compression. No patients required intraoperative cardiothoracic intervention in our institution. The literature search yielded 132 articles and 512 open surgeries for acute posterior sternoclavicular joint injuries. Four patients required intraoperative cardiothoracic intervention, all of whom presented with polytrauma and/or clinical or radiographic signs of neurovascular compromise, giving a combined overall rate of 0.76%. Expert opinion commonly recommends cardiothoracic backup during open surgery for acute posterior sternoclavicular joint injuries. On the basis of our local data and systematic literature review, we found an overall cardiothoracic intervention rate of 0.76%. In the presence of polytrauma and/or findings of neurovascular compromise, we suggest having cardiothoracic surgery on close standby during the procedure. However, a patient with an isolated acute posterior sternoclavicular joint injury and no clinical or radiographic findings of neurovascular compromise does not appear to require a cardiothoracic surgeon on standby. Ultimately, the decision to involve cardiothoracic backup during open surgery for an acute posterior sternoclavicular injury should be made on a case-by-case basis after a thorough physical and radiographic evaluation of the patient. Level III.

Posterior sterno-clavicular joint dislocation in a young male: a case report

Posterior sterno-clavicular joint dislocation in a young male: a case report

The sternoclavicular joint: a review of anatomy, injury and management

The sternoclavicular joint is the only true joint connecting the upper limb with the axial skeleton and is reliant on its capsular and ligamentous attachments for stability. Injuries to the sternoclavicular joint are uncommon and include sprains, dislocations, and fractures. Dislocations and medial clavicle fractures are often associated with high-energy trauma and can lead to life-threatening complications secondary to mediastinal injuries, particularly with posterior sternoclavicular joint dislocations. Given the rarity of these injuries, there are multiple case reports and retrospective studies detailing novel surgical techniques for managing injuries of the sternoclavicular joint and no single option has been implemented. We conducted a literature search on Medline, EMBASE and CINAHL to identify relevant articles focusing on sternoclavicular joint dislocation and subluxation, and medial clavicle fractures in adults. This review article aims to describe: the anatomy of the sternoclavicular joint; injuries including dislocation and medial clavicle fractures; and current investigation and management options including closed and open reduction techniques.

Children’s orthopaedics

The August 2023 Children’s orthopaedics Roundup360 looks at: DDH: What can patients expect after open reduction?; Femoral head deformity associated with hip displacement in non-ambulatory cerebral palsy; Bony hip reconstruction for displaced hips in patients with cerebral palsy: is postoperative immobilization indicated?; Opioid re-prescriptions after ACL reconstruction in adolescents are associated with subsequent opioid use disorder; Normative femoral and tibial lengths in a modern population of USA children; Retrospective analysis of associated anomalies in 636 patients with operatively treated congenital scoliosis; Radiological hip shape and patient-reported outcome measures in healed Perthes’ disease; Significantly displaced adolescent posterior sternoclavicular joint injuries.

Posterior sternoclavicular dislocation in a 15-year old boy: case report

Posterior sternoclavicular joint dislocation is a very rare injury, representing less than 5% of all shoulder girdle injuries. While anterior dislocations may be treated non-operatively, posterior dislocations should either be reduced closed or open and fixed. In cases of concomitant injuries to the mediastinal structures, an open reduction is mandatory. We present a case of a 15-year old boy who presented with a posterior sternoclavicular joint dislocation without concomitant injuries in whom we have performed a chest X-ray but a computerised tomography was needed for a definitive diagnosis. An open reduction and cerclage with 3 non-absorbable sutures provided a stable fixation and the patient remained free of symptoms during the follow-up period.

Figure of Eight FiberTape Stabilization for Acute Posterior Sternoclavicular Joint Dislocation

Figure of Eight FiberTape Stabilization for Acute Posterior Sternoclavicular Joint Dislocation

The Floating Clavicle: Surgical Technique for Management of an Ipsilateral Acromioclavicular and Sternoclavicular Joint Dislocation

Bipolar “floating” clavicle injuries are infrequent upper-extremity injuries that occur secondary to a high-energy trauma, which can cause dislocation at the sternoclavicular (SC) and acromioclavicular joints. Given the rarity of this injury, there is not a consensus regarding clinical management. Although anterior dislocations can be managed nonoperatively, posterior dislocations may pose a threat to chest-wall structures and typically are managed surgically. Here, we present our preferred technique for concomitant management of a locked posterior SC joint dislocation with associated grade 3 acromioclavicular joint dislocation. Reconstruction of both ends of the clavicle was performed in this case, using a figure-of-8 gracilis allograft and nonabsorbable suture reconstruction for the SC joint, and an anatomic acromioclavicular joint and coracoclavicular ligament reconstruction with semitendinosus allograft and nonabsorbable suture.

Magnetic Resonance Imaging in the Management of Significantly Displaced Adolescent Posterior Sternoclavicular Joint Injuries.

Computed tomography (CT) scans are the standard imaging modality for the diagnosis and treatment guide for adolescent posterior sternoclavicular joint (SCJ) injuries. However, the medial clavicular physis is not visualized and it is not possible to differentiate between a true SCJ dislocation and a physeal injury (PI). An magnetic resonance imaging (MRI) scan can visualize the bone and the physis. We treated a series of patients with adolescent posterior SCJ injuries diagnosed on CT scan. Patients underwent an MRI scan to differentiate between a true SCJ dislocation and a PI and to further differentiate between a PI with or without residual medial end clavicular bone contact. Patients with a true SCJ dislocation and a PI with no contact underwent an open reduction and fixation. Patients with a PI with contact were treated nonoperatively with repeat CT scans at 1 and 3 months. At final follow-up SCJ clinical function was assessed using Quick-DASH, Rockwood, modified Constant, and single assessment numeric evaluation (SANE) scores. Thirteen patients (2 female and 11 male) with an average age of 14.9 years (12 to 17) were included in the study. Twelve patients were available at final follow-up (mean 50mo, 26 to 84). One patient had a true SCJ dislocation and 3 had an off-ended PI and were treated with an open reduction and fixation. Eight patients had a PI with residual bone contact and were treated nonoperatively. For these patients serial CT scans showed that the position was maintained, with a serial increase in callus formation and bone remodeling. The average follow-up was 42.9 months (24 to 62). At final follow-up the mean Quick-disabilities of the arm, shoulder and hand (DASH) was 0.4 (0 to 2.3), Rockwood was 15, modified Constant was 98.8 (89 to 100) and SANE was 99.5% (95 to 100). In this case series of significantly displaced adolescent posterior SCJ injuries MRI scans allowed identification of true SCJ dislocations and off-ended PIs, which were successfully treated by open reduction, and PIs with residual physeal contact which were successfully treated nonoperatively. Level IV-case series.

Reconstruction of posterior dislocation of the sternoclavicular joint with nonabsorbable No. 5 ethibond sutures

Posterior sternoclavicular joint dislocation (PSCJD) is rare. It is usually due to contact sports or trauma and is often associated with multiple life-threatening complications. We report a case of a Kabaddi player (an Indian contact sport) who was pushed by an opponent and fell on his right shoulder. The patient complained of right shoulder pain and visible deformity over the right sternal area. After initial X-rays, the right posterior dislocation of the sternoclavicular joint was confirmed with computed tomography scan. After the attempts of closed reduction failed, open reduction and internal fixation were done with a double loop of No. 5 ethibond sutures. Excellent results can be achieved in PSCJD using open reduction and reconstruction techniques with double-stranded 5.0 ethibond nonabsorbable sutures.

Traumatic Left Posterior Sternoclavicular Joint Dislocation with Figure of 8 Semitendinosus Ligament Reconstruction

Traumatic Left Posterior Sternoclavicular Joint Dislocation with Figure of 8 Semitendinosus Ligament Reconstruction

Superior Sternoclavicular Dislocation Treated with Costoclavicular Ligament Reconstruction Using Autograft: A Case Report.

We describe a case of a traumatic superior dislocation of the sternoclavicular joint (SCJ) due to an isolated rupture of the costoclavicular ligament (CCL). A magnetic resonance imaging (MRI) scan demonstrated the CCL rupture with preservation of the anterior and posterior SCJ ligaments. This was successfully treated with an isolated hamstring tendon reconstruction of the CCL, resulting in a satisfactory outcome at 1 year after the procedure. Isolated CCL reconstruction with a hamstring tendon in a patient with a superior SCJ dislocation provided a satisfactory outcome.

Surgical Treatment of Traumatic Posterior Sternoclavicular Joint Dislocation: А Case Report.

Posterior sternoclavicular joint dislocation is a rare condition. In this paper, we present a 51-year-old male patient who was admitted to the emergency department in our hospital after he was hit by a mining railway wagon in the chest. A diagnosis of posterior sternoclavicular dislocation was confirmed after performing a CT scan. Following necessary preparations, the sternoclavicular joint was stabilized with two wire cerclage techniques during open reduction. During control at the postoperative 4th week, the range of motion at the shoulder was satisfactory, but the patient had mild pain at the joint level and was sent to physical therapy to improve the range of motion and to minimize the pain.

Sternoclavicular Joint Reconstruction with Semitendinosus Allograft and Suture Anchors after Recurrent Posterior Dislocation in a Professional North American Football Player

Background: Posterior sternoclavicular joint dislocations are an extremely rare but potentially life-threatening injury that can occur in sports. A variety of surgical procedures have been proposed, but there is no consensus on the treatment of choice. It is also largely unknown if a safe return to high-risk sports is possible. Case Presentation: We present a case of a posterior sternoclavicular joint dislocation in a 22-year-old male professional North American football player who had a recurrent irreducible posterior dislocation after initial injury management by closed reduction. The patient’s desire to return to football presented unique challenges to management. His sternoclavicular joint was subsequently reconstructed with semitendinosus allograft in a figure-of-eight augmented with suture anchors. After recovery, he returned to play as a running back in professional football symptom-free. Conclusion: Our patient's successful return to playing professional football after the sternoclavicular joint reconstruction suggests that this should be considered an effective treatment option when managing posterior sternoclavicular dislocation in high level contact sports players.

Clinical Outcomes and Return to Sports After Open Reduction and Hamstring Tendon Autograft Reconstruction in Patients With Acute Traumatic First-Time Posterior Dislocation of the Sternoclavicular Joint

Background: Traumatic posterior dislocations of the sternoclavicular joint (SCJ) are rare. Multiple case reports, case series, and systematic reviews have been published on the treatment of posterior SCJ dislocations. However, they have usually been of small numbers, described a variety of surgical techniques on a mixture of acute and chronic dislocations, and have not focused on functional recovery or return to sports. Purpose/Hypothesis: The purpose of this study was to assess the clinical outcomes and return to sports after SCJ open reduction and reconstruction using a hamstring tendon autograft in patients with an acute first-time traumatic posterior dislocation of the SCJ. We hypothesized that SCJ open reduction and reconstruction would result in high survivorship, good clinical outcomes, and a high rate of return to sports. Study Design: Case series; Level of evidence, 4. Methods: This study included all patients who underwent SCJ open reduction and reconstruction within 14 days of sustaining a first-time traumatic posteriorly dislocated SCJ, with a minimum 3-year follow-up. Patient-reported outcomes were assessed by the following scores: short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), Rockwood SCJ, modified Constant, and Single Assessment Numeric Evaluation (SANE). Survivorship was defined as no clinical failure, such as instability or recurrent dislocation, and no revision surgery. Return to sports was assessed using a customized questionnaire. Results: A total of 19 patients who underwent surgery were included, with a mean age of 30.8 years (range, 18-52 years). Seventeen patients were available at final follow-up at a mean 94.5 months (range, 37-155 months). At final follow-up, the mean scores were as follows: QuickDASH, 4.3 (range, 0-20.4); Rockwood, 13.9 (range, 12-15); modified Constant, 94.4 (range, 71-100); and SANE, 92.1 (range, 70-100). The construct survivorship was 96%. Of the 14 patients who participated in sports, 12 (86%) returned to their preinjury levels. Conclusion: After an acute first-time traumatic posterior SCJ dislocation, open reduction and stabilization with a hamstring tendon autograft, undertaken within 14 days of injury, provides good clinical outcomes and high rates of survivorship and return to sports.

Posterior sternoclavicular joint dislocation, a rare but "dangerous" injury.

A 17 years of age male patient presented with pain and movement restriction of right upper-extremity after a fall from his bicycle. On examination local swelling, tenderness, and depression of the medial end of the clavicle were present. Any attempt of shoulder movement was causing excruciating pain in this area. There was no other apparent injury and apart from the above-mentioned symptoms and clinical findings, all patients' vital signs were normal. No prominent fracture or other pathology were noticed on X-rays. The clinical findings were compatible with an injury of the sternoclavicular joint; a posterior sternoclavicular joint (SCJ) dislocation in particular. Posterior dislocation of the SCJ can be associated with injuries of the structures that lie behind the manubrium resulting in life threatening complications such as neurovascular, tracheal and oesophageal injuries. Therefor prompt diagnosis and treatment is required. Based on the clinical findings, a computed tomography (CT) was performed and the clinical suspicion was confirmed (A,B). The dislocation was reduced under general anesthesia by closed means, followed by arm immobilization.

Techniques for Reduction and Fixation of the Sternoclavicular Joint.

This video demonstrates the relevant anatomy, approach, and surgical techniques for reduction and fixation of the sternoclavicular joint in both the acute and chronic settings. Fixation techniques demonstrated include transosseous suture fixation, figure-of-eight autograft/allograft fixation, and transarticular plating. A step-by-step guide is provided with demonstration video on cadaveric specimens for each technique, along with a case example that demonstrates acute reduction and fixation of a posterior sternoclavicular joint dislocation.

Sternoclavicular Joint Instability: Symptoms, Diagnosis And Management.

Sternoclavicular joint (SCJ) instability is a rare condition and results from either a traumatic high energy impact, such as a motor vehicle crash or contact sports injury, or non-traumatically as a result of structural pathology. The infrequency of this injury has contributed to its diagnosis being missed as well as the paucity of literature on treatment and outcomes. Patients with SCJ instability often report diminished range of motion as well as shoulder girdle pain. The presentation of instability in the sternoclavicular joint can vary in severity and anterior or posterior directionality. Variation in severity of the instability changes the course of treatment regarding either operative or non-operative interventions to stabilize the SCJ. In general, anterior instability of the SCJ (the medial clavicle is displaced anterior to the sternum) is less urgent and generally manageable by symptom alleviation and rehabilitation, although some anterior instability cases require surgical intervention. In the case of posterior SCJ instability (the medial clavicle is displaced posterior to the sternum), patients require prompt joint reduction as they are at the greater risk of life-threatening injury due to the location of critical structures of the mediastinum posterior to the SCJ. Computed tomography visualization is useful to confirm dislocation or subluxation direction to better formulate a proper treatment plan. The purpose of this review is to report the clinical presentation and management of SCJ instability including pertinent symptoms, the diagnostic approaches to evaluating SCJ instability, as well as operative and non-operative management of the joint instability.

Migrated posterior sternoclavicular joint dislocation into the mediastinum along with clavicle diaphyseal fracture in a child

Migrated posterior sternoclavicular joint dislocation into the mediastinum along with clavicle diaphyseal fracture in a child

A rare case of posterior sternoclavicular joint dislocation in a motorcycle rider

A rare case of posterior sternoclavicular joint dislocation in a motorcycle rider

Clinical Outcomes and Complications Following Surgical Management of Traumatic Posterior Sternoclavicular Joint Dislocations: A Systematic Review.

Traumatic posterior sternoclavicular joint dislocations are rare orthopaedic emergencies. Treatment typically consists of closed reduction, with surgical management reserved for unstable cases. Because of the low prevalence of this condition, limited clinical evidence exists for a superior surgical stabilization technique. A systematic review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. MEDLINE and Embase databases were searched using a comprehensive search strategy. A descriptive and critical analysis of the results was performed. Forty relevant studies (108 cases) were identified. Favorable subjective and objective outcomes were reported for all 5 categories of stabilization described. The overall complication rate was 16%, including 4 cases of recurrent instability. Ligament reconstruction using tendon graft had the lowest recurrent instability and complication rates, and open reduction and internal fixation techniques required a second operation for implant removal in 80% of cases. A comprehensive review of the surgical management of traumatic posterior sternoclavicular joint dislocations is presented. Results suggest favorable outcomes for all of the methods of stabilization, with a modest complication rate. The trends observed have helped to guide the development of clinical care recommendations that aid in treatment decision-making for these injuries. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.