Superior sternoclavicular dislocation: A case report

IntroductionSternoclavicular dislocations are difficult to diagnose and often missed.Anterior dislocations are more common than posterior dislocations and typically have a low risk of complications.Presentation of caseWe report the third case of post-traumatic superior sternoclavicular dislocation, which was successfully treated by functional treatment.DiscussionThe sternoclavicular joint is a diarthrodial joint with three degrees of freedom that is relatively immobile and incongruent.The treatment strategy for these injuries is based on two criteria: the possibility of vascular, nerve or tracheal compression such as in posterior dislocations, which is a surgical indication because of potential risk to life and function; the second indication is to improve esthetics, which is especially a concern with anterior dislocations.ConclusionSuperior sternoclavicular dislocation is a rare condition, with only three published cases up to now. Functional treatment can be used without complications.     

Posterior sternoclavicular dislocations: a review of management and complications

Posterior sternoclavicular dislocations are relatively uncommon injuries. Nevertheless, these dislocations are associated with potentially fatal injuries to the mediastinum and the great vessels. Medial clavicle physeal injury with posterior dislocation may present with a similar clinical picture in younger patients. There is a wide variety of techniques for managing these injuries. In this article, we review recent techniques for reducing and managing posterior sternoclavicular dislocations.     

Superior sternoclavicular joint dislocation presented with shoulder motion limitation: A case report and literature review

Introduction and importanceSternoclavicular joint dislocation accounts for 1 percent of the human joint dislocations. Sternoclavicular joint dislocation most commonly occurs in anterior or posterior dislocation. To the best of the authors knowledge, only six cases of superior sternoclavicular joint dislocation are reported in the literature. The injury is commonly missed.Case presentationWe present a 28-year-old athlete with upper chest pain and right shoulder range of motion limitation. On imaging, it was revealed that he had a superior sternoclavicular dislocation. He was managed with arm sling, analgesics and physiotherapy. After 3 months, he was asymptomatic and returned to his sport activity successfully.Clinical discussionWe searched the published related studies and summarized the signs and symptoms of patients presented with sternoclavicular dislocation. Chest pain is one of the most common symptom while sternoclavicular tenderness and restriction of shoulder movement are among the most common signs of sternoclavicular dislocations. Conservative, close reduction, and open reduction and internal fixation with fiber wire have been applied for cases with superior sternoclavicular dislocation with acceptable results.ConclusionA high index of suspicion is needed in order not to miss sternoclavicular dislocation. In cases with no evidence of mediastinal structure compression it may be managed conservatively successfully. However, some degree of cosmetic deformity may remain at the sternoclavicular joint in those treated with conservative therapy.     

K-wire and tension band wire fixation in treating sternoclavicular joint dislocation

Objective: To evaluate the feasibility and therapeutic effect of treating sternoclavicular joint dislocation by K-wire and tension band wire fixation, and to improve the safety and stability of this technique.Methods: This study consisted of 9 cases, 6 males and 3 females with the mean age of 25 years (range, 9-62 years).The causes were traffic accident in 7 cases, falling in 1 case and fight in 1 case. The duration from injury to operation was 2 hours to 7 days. There were 5 left dislocations and 4right dislocations; 8 anterior dislocations and 1 posterior dislocation, including one combined with left scapular fracture and one with left olecranon fracture. Open reduction and internal fixation using K-wires and tension band wires were performed to treat dislocations.Results: All patients were followed up for 6 to 24months, 10 months on average. According to Rockwood's rating scale on postoperative sternoclavicular joint, 8 cases achieved excellent outcomes with an average score of 13.88,and the rest case achieved a good outcome with the score of 12. Anatomical reduction was obtained in all cases. There were no such postoperative complications as severe infection, injury to blood vessel and nerve, failure of fixation,etc. Patients were all satisfied with the anatomical reduction and functional recovery.Conclusions: The technique of K-wire and tension band wire fixation is safe, simple, effective, less invasive and has been successfully used in orthopedic surgery. It is effective in treating sternoclavicular joint dislocation though it has some disadvantages.     

Lussazione dell’articolazione sternoclavicolare

Dislocation of the sternoclavicular joint is a rarely injury. Dislocations can be anterior or posterior. Anterior dislocation is a usually relatively benign injury, while posterior dislocations may be very serious. In addition to the standard projections, there are also special views for joint evaluation. Computed tomography remains the gold standard. In anterior dislocations, and degree I and II posterior instability, the treatment is conservative, while in case of degree III dislocations, the treatment consists in closed reduction. Operative stabilisation must be considered if closed reduction is unsuccessful.     

Short-term outcomes after surgical treatment of traumatic posterior sternoclavicular fracture-dislocations in children and adolescents

Posterior sternoclavicular joint (SCJ) dislocations and posteriorly displaced physeal fractures of the medial clavicle require prompt diagnosis and treatment to prevent persistent symptoms, recurrent instability, and potential complications. The purpose of this investigation was to review one institution's experience with these injuries. A retrospective review of 13 patients with posterior SCJ fracture-dislocations was performed. Average patient age was 14.6 years, and 85% of injuries were sustained during sporting activities. Patients with posterior dislocations underwent ligament repair and those with posteriorly displaced medial clavicular physeal fractures had open reduction and suture stabilization. At an average of 22.2 months follow-up, all patients had excellent functional outcomes. There were no respiratory or neurovascular complications. Skeletally immature patients may expect excellent functional outcomes following surgery for posterior SCJ dislocations or posteriorly displaced physeal fractures of the medial clavicle.     

Dislocations of the sternoclavicular joint: anatomic basis, etiologies, and radiologic diagnosis

Dislocations of the sternoclavicular joint are relatively uncommon, but diagnosis and management can be difficult, with posterior dislocations being potentially very serious. The anatomy of the joint, and the mechanisms of dislocation, are described. The radiologic diagnosis is discussed and three case reports are presented to illustrate varieties of dislocation. Although computed tomography is the ideal method of demonstrating the sternoclavicular joint, some specialized plain film projections are often useful. These should be more widely known and are described and illustrated. Treatment is briefly discussed.     

Die traumatische posteriore Luxation im Sternoklavikulargelenk

Dislocation of the sternoclavicular joint is an uncommon injury. Especially posterior dislocations with potentially life-threatening complications present a challenging situation for the treating surgeon regarding diagnosis and therapy. Reduction and fixation of the joint is the treatment of choice. We present the case of such an injury in an adolescent judoka who was treated by open reduction and reconstructive surgery using the gracilis tendon graft technique.     

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.     

Posterior sternoclavicular epiphyseal fracture-dislocation: Case report and review of literature

Posteriorly displaced physeal fractures of the medial clavicle are relatively rare injuries in the growing skeleton and are often confused with the posterior dislocations of the sternoclavicular joint (SCJ). Frequently, these initially undiagnosed due to variable clinical presentation and inadequate visualisation of the joint on plain radiographs. This failure of diagnosis or delayed treatment may lead to serious complications though secondary injuries of mediastinal structures.We present a case report of a 16-year-old male with posterior sternoclavicular epiphyseal fracture-dislocation without vasculonervous injury that occurred in basketball training. The correct diagnosis required multiple modalities over two emergency department visits. Computed tomography with intravenous contrast was the imaging modality of choice for diagnosis. Treatment consisted of attempts at closed reduction, which was not successful. Open reduction was performed with relocation of the clavicle into the periosteal sleeve followed by strong suture material. We have reviewed the literature to provide an insight with regards to correct diagnosis and management of this injury.     

Die traumatische sternoklavikuläre Instabilität Eine therapeutische Alternative

Traumatic instability of the sternoclavicular joint is a rare diagnosis. It is usually treated by different bandaging techniques without the possibility of early functional aftercare. In the period between 1 January 1996 and 31 December 1998, a total of eight patients with unstable sternoclavicular joints requiring surgical treatment were treated with Balser plates. The population comprised seven anterior and one posterior dislocations. The results achieved with this alternative treatment option, which offers the advantage of enabling early functional aftercare, are presented. Seven of eight patients were available for follow-up. The eighth patient moved from the area. The Constant Score ranged between 84 and 100 points (average 89 +/- 6.6).     

Balser plate stabilization: an alternate therapy for traumatic sternoclavicular instability

Traumatic instability of the sternoclavicular joint is a rare condition. It can be treated by surgical cerclage fixation, which necessitates postoperative immobilization, an approach preventing early postoperative functional rehabilitation. Balser plate stabilization is a therapeutic alternative that does not require extended periods of immobilization. From January 1, 1996, to December 31, 2000, a total of 10 trauma patients with unstable sternoclavicular joints (Allman grade III) requiring surgical management were treated with Balser plate stabilization to allow early physiotherapy. The population included 7 patients with anterior dislocations, 2 with posterior dislocations, and 1 with medial epiphysiolysis in addition to posterior dislocation. Implants were removed from 9 patients after 3 months and 1 patient after 2 months. One year or longer after the procedure, 9 of 10 patients were available for follow-up; 1 patient had moved. The results achieved with this alternative treatment are excellent. There were no cases of redislocation. The only surgical complication was a seroma that required surgical drainage. One patient had arthrosis develop. Outcome was assessed with Constant (range, 84-100; mean, 90.2 +/- 6.6) and DASH (disabilities of the arm, shoulder, and hand) (range, 4.1-16.6; mean, 8.4 +/- 1.4) scores. For the rare case of sternoclavicular joint dislocation requiring open surgical reduction and stabilization, the Balser plate technique is reliable, permits early movement, has good postoperative results, and compares favorably with alternative methods.     

Posterior sternoclavicular dislocations

Twelve cases of posterior sternoclavicular dislocation were seen over 15 years at the Victoria General Hospital and the Izaak Walton Kiliam Hospital for Children in Halifax, NS. Two patients required open reduction of the dislocation but the rest were treated by closed reduction. One of the former group required threaded K wires for stability, but all other dislocations were deemed stable after reduction and application of a figure-of-eight bandage and an arm sling. There were no failures of reduction and no recurrent dislocations; the authors have been successful even in late closed reduction (up to 5 days) and therefore recommend it highly as the primary treatment. Open reduction is much more difficult and hazardous.     

Posterior sternoclavicular inveterate dislocation

The authors report a case of posterior inveterate sternoclavicular dislocation, which came to their observation after tangential resection of the clavicle. They discuss the surgical technique of reduction and stabilization and clinical results. CT scan was the method most-suited to evaluate dislocation of the clavicle.     

Bipolar dislocation of the clavicle or floating clavicle. A report of 3 cases

Bipolar clavicular dislocation is uncommon. It associates an acromioclavicular and sternoclavicular dislocation. The authors review the mechanism of this injury and discuss the treatment. Three patients presented after a trauma of the shoulder a floating clavicle. In 2 patients management was surgical. Abstention was decided for the fourth patient. The pathology of floating clavicle is not completely understood. Two hypothesis were made: 1) two dislocations occur simultaneously; 2) two dislocations occur one after another. Management still difficult. Indications must take into considerations the severity of the injury and the functional consequences in the acromioclavicular joint.     

Ligamentous restraints to anterior and posterior translation of the sternoclavicular joint

This experiment was conducted to determine the primary ligamentous restraints to anterior and posterior translation of the sternoclavicular joint. Twenty-four unpaired cadaver specimens were mounted in a custom fixture. Anterior and posterior translations were measured under a sub-failure load in the intact specimen and again after transecting one randomly chosen ligament (anterior capsule, posterior capsule, interclavicular ligament, and costoclavicular ligament; n = 6 for each group). Cutting the posterior capsule resulted in significant increases in anterior translation and posterior translation. Cutting the anterior capsule produced significant increases in anterior translation. Cutting the costoclavicular and interclavicular ligaments had little effect on sternoclavicular joint translation. The posterior capsule is the most important restraint for anterior and posterior translation of the sternoclavicular joint. The anterior capsule is another important restraint for anterior translation. The costoclavicular and interclavicular ligaments have little effect on anterior or posterior translation of the sternoclavicular joint.     

A 'safe' surgical technique for stabilisation of the sternoclavicular joint: a cadaveric and clinical study

In symptomatic patients with recurrent anterior sternoclavicular dislocation, surgery may be required to stabilise the joint. Posterior sternoclavicular dislocations may also require open reduction and stabilisation due to the complications that may arise. We present a new, 'safe' technique of surgical stabilisation of the sternoclavicular joint that is not technically demanding and does not require exposure of the first rib, as is often the case in other methods described. The repair was tested in cadavers before being employed in three patients and was found to be effective under both static and dynamic loading. The early clinical results prove encouraging.     

Traumatische Verletzungen des Sternoklavikulargelenks

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.     

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.     

Sternoclavicular dislocation: A plea for open treatment

I report 12 cases of dislocation of the sternoclavicular joint. Eight cases were treated by closed reduction and redislocation occurred in five. The result was good in five out of these eight cases. Two cases with a redislocation and poor result were operated on: in one the sternoclavicular joint was successfully reconstructed with a palmaris longus tendon, and in the other the result was poor after medial resection of the clavicle. In four dislocations good results were obtained after primary open reduction, fixation with two Kirschner wires, and suture of the ruptured ligaments. Primary open reduction should probably be preferred in acute cases of sternoclavicular dislocation.