Posterior dislocation of the sternoclavicular joint and epiphyseal disruption of the medial clavicle with posterior displacement in sports participants (original) (raw)
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Revista Brasileira de Ortopedia (English Edition), 2013
a b s t r a c t Posterior sternoclavicular dislocation is a rare traumatic injury that presents a potential risk of injury to mediastinal structures. The diagnosis is fundamentally clinical and treatment is done on an emergency basis. The authors report the clinical case of a young judo athlete with post-traumatic medial epiphyseal fracture-detachment, with posterior displacement (lesion equivalent to posterior sternoclavicular dislocation at pediatric ages). He underwent open reduction and ligament repair by means of a mini-anchor. The radiological and clinical outcome was excellent, and the athlete returned to his sports activity without limitations.
Cureus, 2021
Sternoclavicular joint (SCJ) dislocation is a rare but serious orthopedic injury. Posterior dislocations are more concerning due to the SCJ's proximity to visceral structures such as the trachea, esophagus, subclavian vessels, and brachial plexus. Due to the potential long-term sequelae of missed diagnosis, clinical suspicion should be high when a patient presents with a compression-type injury to the shoulder girdle and pain or deformity to the SCJ. Here we present a case of a 15-year-old soccer player who presented to the emergency department (ED) after a fall onto his right shoulder with additional compound injuries. A posterior SCJ dislocation diagnosis was suspected and confirmed after a computed tomography scan. A successful closed reduction was done in the ED after consultation with cardiothoracic and orthopedic surgery. This case adds to the body of literature describing diagnosis and management of posterior SCJ dislocations.
Incidence, characteristics, and long-term follow-up of sternoclavicular injuries
Journal of Trauma and Acute Care Surgery, 2016
BACKGROUND: The majority of published studies concerning sternoclavicular injuries are case series or systematic reviews. Prospective studies on the subject are hindered by the low incidence of these lesions. The aims of the present study were to provide an overview of this rare entity compared with those described in the literature and to present the long-term clinical outcome. METHODS: We performed a retrospective data analysis of all sternoclavicular injuries treated at a single Level I trauma center from 1992 to 2011. Long-term clinical outcome was assessed using the ASES [American Shoulder and Elbow Surgeons], SST [Simple Shoulder Test], UCLA [University of California-Los Angeles] Shoulder Scale, and VAS [Visual Analog Scale] at latest follow-up. RESULTS: We detected an overall incidence of 0.9% of sternoclavicular injuries related to all shoulder-girdle lesions. Ninety-two patients (52 males and 40 females) with a mean (SD) age of 39.2 (19.5) years (median, 41 years; range, 4Y92 years) were included in this study. The main trauma mechanism was fall. Classification was performed according to Allman, the time point of treatment after initial trauma, and the direction of the dislocation. Nine patients of the 15 Grade III lesions were treated conservatively by closed reduction and immobilization, while four patients were treated surgically by open reduction and internal fixation. Fortynine percent of the patients were available for long-term follow-up at a median of 11.3 years (range, 5.3Y22.6 years) with a mean ASES score of 96.21, SST score of 11.69, UCLA score of 31.89, and VAS score of 0.47. CONCLUSION: We found an overall incidence of 0.9% of sternoclavicular joint injuries related to all shoulder-girdle lesions and of 1.1% related to all dislocations, which is slightly lower compared with those described in the literature. Furthermore, we observed a high number of physeal sternoclavicular injuries with a percentage of 16% and overall good-to-excellent results at long-term follow-up.
Surgical Treatment of Traumatic Posterior Sternoclavicular Joint Dislocation: А Case Report
PRILOZI
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.
Orthopaedic Journal of Sports Medicine
Background: Traumatic anterior dislocations of the sternoclavicular joint (SCJ) are rare. Although they can usually be treated by a closed reduction, the reported subsequent recurrence rate is 50%. Purpose: To determine whether further instability after first-time traumatic anterior dislocation would be prevented by a minimally invasive open repair of the anterior SCJ capsule, augmented with internal bracing. Study Design: Case series; Level of evidence, 4. Methods: Open repair of the anterior SCJ capsule was completed on a series of patients who had sustained a first-time traumatic anterior dislocation of the SCJ. Patients with preexisting SCJ instability and recurrent dislocations were excluded. Through a transverse incision, the anterior SCJ capsule was repaired and plicated by use of sutures. The repair was then protected by use of an internal brace, bridging between the sternum and the medial end of the clavicle. Results: Six patients (4 males, 2 females) with a mean age of 28.3 years were included. Four patients underwent surgery within 4 weeks of their dislocation, and 2 patients had ongoing symptoms of instability but had not had a further dislocation. The median follow-up was 28.2 months (range, 24-35 months). At the most recent follow-up, none of the patients had sustained further dislocation or episode of instability, and their SCJs appeared stable. The mean abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was 2.3 (range, 0-4.5). Conclusion: The medium-term results of this case series suggest that after first-time dislocation, surgical repair of the anterior SCJ capsule augmented with internal bracing can prevent recurrent instability. This may be an attractive option for individuals involved in higher risk activities, as the operative management of recurrent anterior SCJ instability usually requires a figure-of-8 tendon reconstruction, which carries a significantly higher morbidity.
Management of anterior sternoclavicular dislocation: a survey of orthopaedic surgeons
Acta orthopaedica Belgica, 2012
Acute and chronic symptomatic anterior sternoclavicular (SC) dislocations are rare; various treatment options have been described. With the purpose of surveying current practices and opinions concerning treatment of these lesions, we sent a questionnaire to members of a general orthopaedic society, a national shoulder society and an international shoulder society. Closed reduction was attempted by 52% of the respondents, but > 80% of the surgeons stated that the reduction was not maintained in more than half of the dislocations. The procedure preferred by the respondents--explicitly by members of the international shoulder society--to deal with chronic symptomatic anterior SC dislocation, is reconstruction of the ligaments. Members of the international shoulder society are more likely to choose operative treatment for chronic symptomatic anterior SC dislocations.
Bilateral Posterior Sternoclavicular Dislocations
Radiology Case Reports, 2009
We present the case of a professional horse jockey with chronic, bilateral, posterior sternoclavicular dislocations. Traumatic dislocation of the sternoclavicular is a relatively rare but potentially devastating injury. Posterior sternoclavicular dislocations occur less frequently than anterior dislocations and require careful and complete evaluation because of the potential for serious complications including respiratory distress, brachial plexus injury, and vascular injury. Our patient was treated with excision of the medial end of the clavicle on her symptomatic side.
Sternoclavicular Joint Injuries in the Contact Athlete
Operative Techniques in Sports Medicine, 2016
Injuries to the sternoclavicular joint are rare, but can be extremely limiting and potentially life threatening due to the proximity of the sternoclavicular joint to critical neurovascular structures. Athletes participating in contact sports are especially susceptible to these injuries as a result of repeated exposure to high-impact collisions. Following both anterior and posterior sternoclavicular instability events, in order to return athletes to their pre-injury activity level, an accurate diagnosis and appropriate treatment plan is paramount. The purposes of this manuscript are to review the relevant anatomy, biomechanics, patient presentation, and management options for sternoclavicular joint injuries. Medical-decision-making and evidence-based clinical outcomes will be described in detail. brachial plexus, trachea, esophagus, and vascular structures, which may lead to life threatening complications. 5,6,7 Recently, the number of techniques, protocols, and biomechanical studies designed to better understand and improve the treatment of SC joint injuries has substantially increased. 1 Unfortunately, the large body of recent literature is replete with varied findings, resulting in some uncertainty with regard to proper treatment options for SC joint injuries. 2,8 In the subsequent sections, the relevant clinical and biomechanical anatomy of the SC joint, along with clinical decision-making principles for SC joint injuries will be reviewed. In particular, specific attention will be given to the senior author's preferred operative techniques. Lastly, clinical outcomes following treatment of SC joint injury reported in the literature will be reviewed.