Reconstruction for instability of the sternoclavicular joint using the tendon of the sternocleidomastoid muscle

We describe a new method of stabilising a painful unstable sternoclavicular joint using the sternocleidomastoid tendon and passing it through the medial clavicle and onto the manubrium sternum. This method is simple, reproducible and avoids the potential risks of reefing the joint to the first rib. The technique was used in seven cases of sternoclavicular joint instability in six patients who were reviewed at a mean of 39.7 months (15 to 63). Instability was markedly reduced or eliminated in all cases, but in one there was occasional persistant subluxation. There were minor scar complications after two procedures and one patient had transient ulnar neuritis. This procedure provides satisfactory results in the medium term.     

Operative treatment of the painful sternoclavicular joint: a new technique using interpositional arthroplasty

This study presents the results of a new surgical technique, resection of the medial end of the clavicle and interposition of the sternal head of the sternocleidomastoid muscle, that was used for the treatment of 17 painful sternoclavicular (SC) joints, 14 of which were available for review. The etiology of the pain was primary or posttraumatic degenerative arthritis in 10, osteitis condensans in 2, and SC joint infection in 2. The results of surgery, evaluated with the Rockwood SC joint rating scale and examination of the patients, were determined at a mean follow-up of 46 months. Results were excellent in 4 shoulders, good in 6, fair in 3, and poor in 1. All of the fair and poor results occurred in workers' compensation patients. Interposition arthroplasty performed in conjunction with resection of the medial clavicle proved to be a safe and effective method of treatment for the painful, degenerative or septic SC joint.     

Safe surgical technique: reconstruction of the sternoclavicular joint for posttraumatic arthritis after posterior sternoclavicular dislocation

Posttraumatic sternoclavicular arthritis related to chronic ligamentous instability after posterior sternoclavicular dislocation represents a rare but challenging problem. The current article in the Journal’s “Safe Surgical Technique” series describes a successful salvage procedure by partial resection of the medial clavicle and ligamentous reconstruction of the sternoclavicular joint with a figure-of-eight semitendinosus allograft interposition arthroplasty.     

Luxations in the sternoclavicular joint

Primary open reduction and fixation with Kirschner wires and/or fascia lata or PDS is recommended in the treatment of acute traumatic luxations of the sternoclavicular joint. If not bent or secured against migration, K-wires may be the reason for lethal postoperative complications. We report on 7 own patients with luxation of the sternoclavicular joint and discuss the problems in diagnosis, operative and postoperative treatment of this rare lesion.     

锁骨钩钢板在胸锁关节脱位治疗中的应用

目的:探讨应用锁骨钩钢板治疗胸锁关节脱位的方法及疗效。方法:2010年1月至2014年3月,采用锁骨钩钢板固定治疗胸锁关节脱位患者6例,其中男5例,女1例;年龄26～48岁,平均34岁;病程3～20 d.患者均为外伤后患侧胸锁关节肿胀、疼痛,患侧肩关节活动明显受限,经X线片及CT诊断为胸锁关节前脱位,根据Rockwood评分法对术后疗效进行评价。结果:所有患者术后切口愈合良好,外观美观;X线片显示胸锁关节脱位复位良好,钢板位置良好。6例患者均获随访,时间4～18个月,平均12个月。根据Rockwood评分法进行疗效评定:优4 例,良 1 例,可 1 例,未见内固定失效及再脱位,无血管、神经及胸膜等副损伤。结论:锁骨钩钢板能在复位固定胸锁关节的同时保留胸锁关节微动功能,且不损伤胸锁关节软骨面。手术安全性高,固定效果好,患者术后可进行早期康复锻炼。     

Pseudo-dislocation of the sternoclavicular joint

Fractures of the medial third of the clavicle are the rarest of all clavicle fractures. We present two cases of medial clavicle fracture nonunions that were initially thought to be chronic anterior sternoclavicular dislocations and describe the entity of pseudo-dislocation of the sternoclavicular joint. Computed tomography should be performed on all patients with suspected or established injuries of the sternoclavicular region to ensure differentiation between fracture and dislocation.     

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.     

Disorders of the sternoclavicular joint

The sternoclavicular joint is vulnerable to the same disease processes as other synovial joints, the most common of which are instability from injury, osteoarthritis, infection and rheumatoid disease. Patients may also present with other conditions, which are unique to the joint, or are manifestations of a systemic disease process. The surgeon should be aware of these possibilities when assessing a patient with a painful, swollen sternoclavicular joint.     

Surgical treatment of sternoclavicular joint infections in cirrhotic patients

BACKGROUND: Cirrhotic patients with sternoclavicular joint (SCJ) infection pose a unique challenge for which there are no management guidelines. We reviewed our experience with this unusual infection in this high-risk patient population. METHODS: We performed a retrospective analysis of all patients with cirrhosis (n = 5) treated surgically for SCJ infection from January 1998 to July 2006. RESULTS: All infections were locally advanced with bone necrosis, complex abscess formation, or mediastinal involvement. En bloc SCJ resection was performed in 3 patients. A more conservative approach of incision and drainage with debridement was performed in 2 patients. Sepsis and/or pulmonary compromise occurred in all patients postoperatively and the surgical mortality rate was 40%. All deaths occurred after en bloc SCJ resection. CONCLUSIONS: Sternoclavicular joint infections in cirrhotic patients tend to be extensive in nature and pose a high surgical risk. Adequate surgical drainage and debridement may be better tolerated than a radical en block resection.     

Dislocations of the sternoclavicular joint

The effects of the anterior and posterior sternoclavicular joint (SCJ) soft tissue structures on joint dislocation strength by sequential sectioning the ligaments and capsule of twenty-eight SCJs were evaluated. The medial clavicle of each specimen was initially loaded in the anterior and posterior directions to provide control values for joint laxity. The anterior or posterior ligaments and capsular structures of the SCJs were then selectively cut and the specimens retested for laxity and then loaded to failure simulating either anterior or posterior dislocation. Testing of intact specimens showed that the posterior ligaments were stiffer than other structures in that it was significantly more difficult to posteriorly displace the SCJ than in any other direction and that the capsule was the important anterior structure affecting joint laxity. Load-to-failure testing showed that it required 50% more force to create a failure by posterior dislocation than by anterior dislocation. The results of this study explain the clinical rarity of posterior sternoclavicular joint dislocations.     

Interposition arthroplasty with bone-tendon allograft: a technique for treatment of the unstable sternoclavicular joint

Sternoclavicular joint instability is an uncommon but challenging clinical problem for the orthopaedic surgeon. Although most cases can be treated nonoperatively with minimal long-term pain or functional limitation, a small percentage may require surgical intervention. This includes chronic anterior instability associated with persistent pain or functional limitation as well as irreducible or recurrent posterior instability. Although numerous procedures have been described for treatment of the unstable sternoclavicular joint, the optimal method for stabilization has not been determined. Here we describe a technique using Achilles tendon allograft to create an interpositional arthroplasty and briefly present 3 illustrative cases in which we performed the procedure. We believe this method effectively stabilizes the joint, restores function, relieves pain, and has applications for traumatic sternoclavicular instability as well as instability related to other etiologies.     

Traumatic injuries of the sternoclavicular joint

Traumatic injuries of the sternoclavicular joint occur rarely and are mainly caused by an indirect trauma mechanism with high kinetic energy. Anterior dislocation is much more common than posterior dislocation, which may be associated with life-threatening injuries. The CT scan is the diagnostic tool of choice for accurate assessment of the injury and coexisting pathologies. The primary goal in anterior and posterior dislocations is an early closed reduction. In cases of redislocation after closed reduction of an anterior dislocation we recommend primary joint reconstruction on the basis of an individual therapeutic concept. Posterior dislocations often cannot be reduced by closed means. Then open reconstruction and stabilization are performed. Chronic instabilities should only be addressed surgically in cases of persistent pain and/or functional deficit. Resection of the medial clavicula represents an effective treatment option in post-traumatic sternoclavicular joint arthritis provided that the costoclavicular ligaments are intact or will be reconstructed during surgery. Physeal injuries of the medial clavicle can occur until an approximate age of 25. Closed reduction of dislocated physeal injuries is attempted. After reposition non-operative treatment in general leads to a good functional outcome. Posteriorly dislocated physeal injuries often cannot be reduced by closed means. In these cases good function can be expected after open stabilization.     

Atraumatic disorders of the sternoclavicular joint

The sternoclavicular joint is the diarthrodial articulation between the axial and appendicular skeletons. It is subject to the same disease processes that occur in joints, including degenerative arthritis, rheumatoid arthritis, infection, and subluxation. Most of these conditions present with swelling of the joint, which may be associated with pain and/or tenderness. Plain radiographs can demonstrate changes on both sides of the joint. Because of variations in anatomy, computed tomography scans and magnetic resonance images are often necessary to clarify the pathology. With the exception of acute infection, most conditions can be managed nonsurgically, with joint resection reserved for patients with persistent symptoms.