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Alnasser A, Alamari ZS, Almutairi TM, Aljohani HT, Almulla AM. Sternoclavicular Septic Arthritis and Surgical Intervention: A Case Report. Cureus 2024; 16:e53002. [PMID: 38406090 PMCID: PMC10894666 DOI: 10.7759/cureus.53002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/27/2024] Open
Abstract
Management of septic arthritis is an area of controversy, especially in rare locations like the sternoclavicular joints. In this case report, we present a case of septic sternoclavicular joint, which was resistant to medical treatment and deteriorated during the treatment course. Although medical treatment has proven effective based on previous literature, some cases will still not benefit from it. In this case, our patient responded significantly to surgical treatment regarding upper limb function, faster infection eradication and rehabilitation, and shorter hospitalization and antibiotics duration.
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Affiliation(s)
- Abdullah Alnasser
- Orthopaedic Surgery, Prince Sultan Military Medical City, Riyadh, SAU
| | - Zeyad S Alamari
- Orthopaedics, Prince Sultan Military Medical City, Riyadh, SAU
| | - Taif M Almutairi
- College of Medicine, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Hamid T Aljohani
- Orthopaedic Surgery, Prince Sultan Military Medical City, Riyadh, SAU
| | - Ahmed M Almulla
- Orthopaedics and Traumatology, Prince Sultan Military Medical City, Riyadh, SAU
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2
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Khalid N, Afzal MA, Haider SU, Michael P, Abdullah M. A Challenging Case of Managing Septic Arthritis of the Sternoclavicular Joint in a Patient With a History of Intravenous Opioid Use Disorder: A Case Report and Literature Review. Cureus 2023; 15:e42635. [PMID: 37644935 PMCID: PMC10461129 DOI: 10.7759/cureus.42635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Septic arthritis of the sternoclavicular joint (SCJ) is a rare condition with limited literature available. We present a case of a 31-year-old female patient with a history of opioid drug use who presented with septic arthritis of the left SCJ. The patient exhibited chest wall pain; imaging revealed septic arthritis with an associated retrosternal abscess. Treatment with antibiotics alone resulted in the resolution of the abscess, highlighting the potential for medical management without surgical intervention. This case report and literature review emphasizes the importance of considering septic arthritis in patients with vague chest pain, particularly those with a history of intravenous drug use, and raise awareness about the complications associated with opioid use.
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Affiliation(s)
- Noman Khalid
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | | | - Safee Ullah Haider
- Internal Medicine, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College, Shaikh Zayed Federal Postgraduate Medical Institute at Shaikh Zayed Medical Complex, Lahore, PAK
| | - Patrick Michael
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Muhammad Abdullah
- Public Health and Community Medicine, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College, Shaikh Zayed Federal Postgraduate Medical Institute at Shaikh Zayed Medical Complex, Lahore, PAK
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3
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Walker JK, Cronin JT, Richards BW, Skedros JG. Acute Sternoclavicular Joint Sepsis With Medial Clavicle Osteomyelitis (Staphylococcus aureus) and Cervical-Thoracic Epidural Phlegmon in an Adult Female With No Apparent Risk Factors. Cureus 2023; 15:e35870. [PMID: 37033534 PMCID: PMC10079283 DOI: 10.7759/cureus.35870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/09/2023] Open
Abstract
This is a case of a 71-year-old female with a history of only one known medical problem (hypertension) who presented with a right sternoclavicular joint (SCJ) infection in addition to (1) a contiguous lower cervical and upper thoracic epidural phlegmon and (2) cellulitis and a phlegmon in her posterior neck, which was subcutaneous and near the lower cervical and upper thoracic spinous processes. These loci of infection developed several days after she had pricked her fingers when cutting rose bushes and were initially considered to be epidural abscesses. However, after the patient was transferred to our tertiary medical center, a neurosurgeon and radiologist determined that the cervicothoracic infections were phlegmons rather than fully developed abscesses. The phlegmons were treated with only IV antibiotics. The SCJ infection was surgically debrided, and the medial clavicle was excised. Bone and fluid cultures grew methicillin-sensitive Staphylococcus aureus (S. aureus). The patient recovered uneventfully (the final follow-up was four years later). This case is uncommon because of the concurrent SCJ infection with medial clavicle osteomyelitis, cervical-thoracic epidural, and paraspinous phlegmons.
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Minimally Invasive Surgery for Sternoclavicular Joint Infection with Osteomyelitis, Large Abscesses, and Mediastinitis. Case Rep Surg 2022; 2022:9461619. [PMID: 36317047 PMCID: PMC9617732 DOI: 10.1155/2022/9461619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/14/2022] [Indexed: 11/12/2022] Open
Abstract
Background Sternoclavicular joint infections require en bloc resection for radical cure; however, this aggressive procedure may result in multiple adverse events. Therefore, performing minimally invasive surgery is desirable. In this report, we describe a case of sternoclavicular joint infection complicated by osteomyelitis, large abscesses, and mediastinitis that was successfully treated with incision and drainage. Case Presentation. A 42-year-old man with no medical history presented to our hospital with complaints of painful swelling in the left chest wall and acute dyspnea. Computed tomography revealed arthritis of the left sternoclavicular joint, osteomyelitis of the clavicle and sternum, anterior mediastinitis, and abscesses in the neck, chest wall, and retrosternal and extrapleural spaces. Gram staining of the aspirated pus revealed clusters of gram-positive cocci. A diagnosis of Staphylococcus aureus sternoclavicular joint infection with locoregional spread was made. Emergency surgery was performed following adequate resuscitation. A skin incision was made in the second intercostal space. The joint capsule was widely opened, necrotic tissue was curetted, and closed suction drains were placed in the abscess cavities and connected to a negative pressure system. The wound was then closed using primary sutures. The postoperative course was uneventful. Methicillin-sensitive Staphylococcus aureus was cultured from the pus. The patient was discharged on postoperative day 14. Osteomyelitis worsened within a few weeks after surgery but recovered with wound management and six weeks of antibiotic therapy. The patient has had no recurrence of infection for two years. Conclusions Incision and drainage proved to be an effective minimally invasive surgical treatment for sternoclavicular joint infection with osteomyelitis, large abscesses, and mediastinitis caused by methicillin-sensitive Staphylococcus aureus.
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Luu T, Reid G, Lavery B. Escherichia coli associated hematogenous sternoclavicular joint osteomyelitis: A rare condition with a rare causative pathogen. IDCases 2022; 27:e01381. [PMID: 35036321 PMCID: PMC8749209 DOI: 10.1016/j.idcr.2022.e01381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
Escherichia coli is the most common microorganism that causes urinary tract infections (UTIs), including acute prostatitis. However, E. coli osteomyelitis, especially ones that involve the sternoclavicular joint, are rare hematogenous complications. We present a case of an immunocompetent man who presented with symptoms of UTI and right shoulder pain. Urine cultures and blood cultures grew E. coli. There was radiographic evidence of prostatic abscess and a right sternoclavicular joint osteomyelitis. This case is unique given the rare occurrence of non-traumatic clavicular bacterial osteomyelitis and the type of bacteria involved. In conclusion, it is important for clinicians to be aware of E. coli sternoclavicular osteomyelitis in adults with preceding bacterial prostatitis.
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Affiliation(s)
- Tyler Luu
- Loyola University Medical Center, Department of Internal Medicine, 2160 S 1st Avenue, Maywood, IL 60153, USA
| | - Gail Reid
- Loyola University Medical Center, Department of Internal Medicine, 2160 S 1st Avenue, Maywood, IL 60153, USA
| | - Brian Lavery
- Edward Hines, Jr. VA Hospital, Department of Internal Medicine, 5000 5th Ave, Hines, IL 60141, USA
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Monteiro S, Gomes DS, Moura N, Sarmento M, Cartucho A. Sternoclavicular Septic Arthritis: Partial Resection is Still an Option - A Case Report. J Orthop Case Rep 2021; 11:34-38. [PMID: 35415114 PMCID: PMC8930333 DOI: 10.13107/jocr.2021.v11.i11.2506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/17/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Sternoclavicular joint (SCJ) infection is rare. Delayed diagnosis might lead to severe complications. Optimal surgical management is still under debate however extended resection of the joint requiring muscle flap coverage appears to be the favored approach nowadays in the cases with bony involvement. Case Presentation A 58-year-old man complained of isolated left shoulder and anterior chest pain for over a month. Careful examination revealed a mass over the SCJ. A Computed tomography scan confirmed joint effusion and adjacent bone erosion, with no retrosternal involvement, consistent with SCJ septic arthritis with significant bony involvement. Conclusion This case illustrates how a heightened index of suspicion is essential for diagnosis and prompt treatment, and how partial resection was effective and resulted in complete recovery of range of motion and pain resolution, despite bony involvement. There were no signs of recurrence 1 year after surgery.
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Affiliation(s)
- Sara Monteiro
- Department of Orthopedics and Traumatology, Hospital do Divino Espírito Santo, EPER, Ponta Delgada, Portugal,
Address of Correspondence: Dr. Sara Monteiro, Department of Orthopedics and Traumatology, Hospital do Divino Espírito Santo, EPER, Ponta Delgada, Portugal. E-mail:
| | - Diogo Silva Gomes
- Department of Orthopedics, Shoulder and Elbow Unit, Orthopaedics Department-Hospital CUF Descobertas, Lisboa, Portugal
| | - Nuno Moura
- Department of Orthopedics, Shoulder and Elbow Unit, Orthopaedics Department-Hospital CUF Descobertas, Lisboa, Portugal
| | - Marco Sarmento
- Department of Orthopedics, Shoulder and Elbow Unit, Orthopaedics Department-Hospital CUF Descobertas, Lisboa, Portugal
| | - António Cartucho
- Department of Orthopedics, Shoulder and Elbow Unit, Orthopaedics Department-Hospital CUF Descobertas, Lisboa, Portugal
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Reid R, McKnight RR, Secrist E, Clark C. Sternoclavicular Septic Arthritis Caused by Cutibacterium acnes in a Previously Healthy 13-Year-Old Male: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00024. [PMID: 34264874 DOI: 10.2106/jbjs.cc.20.00690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 13-year-old boy presented with 3 weeks of atraumatic left-sided sternoclavicular (SC) joint pain, swelling, and decreased range of motion. After imaging and laboratory workup, he underwent operative irrigation, debridement, and antibiotic therapy with complete resolution of his symptoms. Surgical cultures were consistent with SC septic arthritis. CONCLUSION The management of septic arthritis in pediatric patients remains varied. Here, we present the only report of SC septic arthritis due to Cutibacterium acnes in a healthy pediatric patient. Given the similar clinical findings of pain and swelling to affected bones and joints, differentiating SC septic arthritis from other conditions within the clinical spectrum of chronic nonbacterial osteomyelitis remains challenging. Clinicians should maintain a high index of suspicion when patients present with pain and swelling over the SC joint.
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Affiliation(s)
- Risa Reid
- Department of Orthopaedic Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina
| | - R Randall McKnight
- Department of Orthopaedic Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina
| | - Eric Secrist
- Department of Orthopaedic Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina
| | - Christian Clark
- Orthocarolina Pediatric Orthopaedic Center, Charlotte, North Carolina
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Son H, Grigovich M, McCabe BE. Non-tumorous diseases of the sternum and its articulations: At the front gate of the chest. Curr Probl Diagn Radiol 2021; 51:628-638. [PMID: 34393035 DOI: 10.1067/j.cpradiol.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/27/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Abstract
Abnormalities of the sternal and peri-sternal regions are commonly seen in clinical practice and may be one of the important causes of chest pain particularly anterior chest wall pain. While reading computed tomography (CT) of the chest for evaluation of chest pain, the sternal region is either easily overlooked or its abnormality is often detected incidentally. This article will provide an overview of normal sternal anatomy and congenital variants as well as a variety of non-tumorous pathologic conditions of the sternum and adjacent joints, with emphasis on CT, to help radiologists, particularly thoracic radiologists, to make an accurate diagnosis in their daily practice. Non-tumorous abnormalities include trauma (fractures and dislocations), infection (osteomyelitis, septic arthritis), degenerative (osteoarthritis) and inflammatory conditions (rheumatoid arthritis, seronegative arthritides), and metabolic disorders (Paget's disease and renal osteodystrophy) as well as treatment related changes such as poststernotomy and its complications (dehiscence, nonunion) and postradiation changes of the sternum.
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Affiliation(s)
- Hongju Son
- Department of Radiology, Einstein Healthcare Network, Philadelphia PA 19401.
| | - Maria Grigovich
- Department of Radiology, Einstein Healthcare Network, Philadelphia PA 19401
| | - Bridgette E McCabe
- Department of Radiology, Einstein Healthcare Network, Philadelphia PA 19401
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Doub JB. A rare case of extensive Staphylococcus aureus sternoclavicular septic arthritis treated without surgical intervention. IDCases 2020; 23:e01023. [PMID: 33364169 PMCID: PMC7753931 DOI: 10.1016/j.idcr.2020.e01023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 11/25/2022] Open
Abstract
This is a rare case of a 55 year-old immunocompetent female who developed Methicillin sensitive Staphylococcus aureus sternoclavicular septic arthritis. The infection was not limited to the joint space but extended into adjacent bones and superior mediastinum. However the patient was successfully treated without surgical intervention and preservation of joint function was obtained with only intravenous antibiotic therapy.
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Affiliation(s)
- James B Doub
- Division of Infectious Diseases, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD, 21201, USA
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10
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Elbawab H, Aljehani Y, AlReshaid FT, Almusabeh HA, Al-Harbi TM, Alghamdi R. Sternoclavicular joint osteomyelitis; delayed bone resection with muscle flap: A case report. Int J Surg Case Rep 2020; 77:426-429. [PMID: 33227690 PMCID: PMC7691679 DOI: 10.1016/j.ijscr.2020.10.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Sternoclavicular joint (SCJ) osteomyelitis is a very rare condition. Here, we report an uncommon case of a complicated SCJ osteomyelitis in a patient with an anterior chest wall trauma. PRESENTATION OF CASE A 61-year-old male a known case of dyslipidemia, hypertension (HTN), and type II diabetes mellitus (T2DM). The patient presented with pain and erythema over the right SCJ following trauma to the same location. Two weeks later, the patient presented with erythematous swelling with a sinus discharging pus, although he was discharged on oral antibiotics, analgesics, and had underwent an incisional drainage. Computerized Tomography (CT) of the chest showed fluid collection surrounding the right SCJ together with joint effusion suggestive of SCJ osteomyelitis. The patient underwent initial debridement and a definitive bone resection with pectoralis muscle flap two weeks following. Five months later, the patient was seen in the outpatient clinic, the wound was completely healed, and he has a normal function of the right arm. DISCUSSION The management of SCJ osteomyelitis is not well established, yet it can be approached medically, surgically, or both. CONCLUSION Surgical intervention is indicated in cases of SCJ osteomyelitis after the failure of antibiotic therapy trial. This is especially the case in the presence of abscess and bone destruction. SCJ debridement followed by delayed resection and pectoralis muscle flap might offer better results than merely debridement alone or with resection of the joint.
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Affiliation(s)
- Hatem Elbawab
- Thoracic Unit, Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
| | - Yasser Aljehani
- Thoracic Unit, Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Farouk T AlReshaid
- Thoracic Unit, Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | | | | | - Rizam Alghamdi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia
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Negative Pressure Wound Therapy Combined With Instillation for Sternoclavicular Joint Infection. Ann Thorac Surg 2020; 110:1722-1725. [DOI: 10.1016/j.athoracsur.2020.04.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 01/31/2023]
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12
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A multi-institutional analysis of sternoclavicular joint coverage following osteomyelitis. Arch Plast Surg 2020; 47:460-466. [PMID: 32971598 PMCID: PMC7520252 DOI: 10.5999/aps.2020.00717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/29/2020] [Indexed: 11/08/2022] Open
Abstract
Background Sternoclavicular joint (SCJ) osteomyelitis is a rare pathology requiring urgent intervention. Several operative approaches have been described with conflicting reports. Here, we present a multi-institutional study utilizing multiple surgical pathways for SCJ reconstruction. Methods A multi-institutional retrospective cohort study was conducted to identify patients who underwent surgical repair for sternoclavicular osteomyelitis between 2008 and 2019. Patients were stratified according to reconstruction approach: single-stage reconstruction with advancement flap and delayed-reconstruction with flap following initial debridement. Demographics, operative approach, type of reconstruction, and postoperative outcomes were analyzed. Results Thirty-two patients were identified. Mean patient age was 56.2±13.8 years and 68.8% were male. The average body mass index (BMI) was 30.0±8.8 kg/m2. The most common infection etiologies were intravenous drug use and bacteremia (both 25%). Fourteen patients (43.8%) underwent one-stage reconstruction and 18 (56.2%) underwent delayed twostaged reconstruction. Both single and delayed-stage groups had comparable rates of reinfection (7.1% vs. 11.1%, respectively), surgical site complications (21.4% vs. 27.8%), readmissions (7.1% vs. 16.6%), and reoperations (7.1% vs. 5.6%; all P>0.05). The single-stage reconstruction group had a significantly lower BMI (26.2±5.7 kg/m2 vs. 32.9±9.1 kg/m2; P<0.05) and trended towards shorter hospital length of stay (11.3 days vs. 17.9 days; P=0.01). Conclusions Both single and delayed-stage approaches are appropriate methods with comparable outcomes for reconstruction for SCJ osteomyelitis. When clinically indicated, a single-stage reconstruction approach may be preferable in order to avoid a second operation as associated with the delayed phase, and possibly shortening total hospital length of stay.
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13
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Hanhoff M, Jensen G, Dey Hazra RO, Lill H. Innovative Surgical Concept for Septic Sternoclavicular Arthritis: Case Presentation of a Simultaneous Joint Resection and Stabilization with Gracilis Tendon Graft Including Literature Review. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 160:64-73. [PMID: 32927491 DOI: 10.1055/a-1219-8342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Septic arthritis of the sternoclavicular joint (SCJ) is a rarity in everyday surgical practice with 0.5 - 1% of all joint infections. Although there are several risk factors for the occurrence of this disease, also healthy people can sometimes be affected. The clinical appearance is very variable and ranges from unspecific symptoms such as local indolent swelling, redness or restricted movement of the affected shoulder girdle to serious consequences (mediastinitis, sepsis, jugular vein thrombosis). Together with the low incidence and the unfamiliarity of the disease among practicing doctors in other specialties, this often results in a delay in the diagnosis, which in addition to a significant reduction in the quality of life can also have devastating consequences for the patient. PATIENT AND METHOD According to a stage-dependent procedure, the therapy strategies range from antibiotic administration only to radical resection of the SC joint and other affected structures of the chest wall in severe cases with the following necessity for flap reconstruction. The aspect of possible post-interventional instability after resection of the SCJ receives little or no attention in the current literature. In the present case report of a 51-year-old, otherwise healthy gentleman with isolated monoarthritis of the right SCJ with Escherichia coli (E. coli) shortly after two prostatitis episodes, the possibility of a new surgical approach with a one-stage eradication and simultaneous stabilization of the SCJ is presented. Therefore, a joint resection including extensive debridement is performed while leaving the posterior joint capsule and inserting an antibiotic carrier. In the same procedure, the SCJ is then stabilized with an autologous gracilis tendon graft by using the "figure of eight" technique, which has become well established particularly for anterior instabilities of the SCJ in recent years. RESULTS AND CONCLUSION One year after operative therapy, the patient presented symptom-free with an excellent clinical result (SSV 90%, CS89 points, CSM 94 points, TF 11 points, DASH 2.5 points). It is concluded that in selected cases with an infection restricted to the SCJ without major abscessing in the surrounding soft tissues, the demonstrated procedure leads to good and excellent clinical results with stability of the joint. If the focus of infection and germ are known, stabilization using an autologous graft can be carried out under antibiotic shielding. To the best of the authors' knowledge, this surgical procedure has not yet been described in the current literature. Depending on the extent of the resection, an accompanying stabilization of the SCJ should be considered to achieve stable conditions and an optimal clinical outcome.
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Affiliation(s)
- Marek Hanhoff
- Orthopaedic and Trauma Surgery, DIAKOVERE Friederikenstift, Hanover
| | - Gunnar Jensen
- Orthopaedic and Trauma Surgery, DIAKOVERE Friederikenstift, Hanover
| | | | - Helmut Lill
- Orthopaedic and Trauma Surgery, DIAKOVERE Friederikenstift, Hanover
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Ali B, Barlas V, Shetty AK, Demas C, Schwartz JD. The Preferred Treatment of Sternoclavicular Joint Infections: A Systematic Review. Cureus 2020; 12:e9963. [PMID: 32983667 PMCID: PMC7510516 DOI: 10.7759/cureus.9963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/23/2020] [Indexed: 11/10/2022] Open
Abstract
The treatment of sternoclavicular joint infection is a topic of controversy. This systematic review aims to evaluate the preferred treatment of sternoclavicular joint infections. A literature search using PubMed/MEDLINE®/Embase databases was conducted to identify publications on the surgical management of sternoclavicular joint infections. Case reports and studies without surgical management were excluded. The outcomes of interest included patient demographics, comorbidities, infectious etiologies, radiographic features, surgical management, and complications. Sixteen articles met the inclusion criteria. The mean age of the subjects was 53.4 years; there was a predominance of males (65%), and a minority of the subjects were obese (15%). The most common infectious etiology was methicillin-susceptible Staphylococcus aureus (MSSA) (48%). CT scan was reported in 46% of cases. The most common treatment was surgical resection of the joints (85%), followed by muscle flap closure of the wounds (54.2%). The complication rate ranged from 0-40%. Specifically, recurrence of infection was low with resection of the joint, followed by muscle flap closure. Given the heterogeneity of the methodology and inconsistency in the outcomes, a meta-analysis could not be performed. Overall, the current literature favors the resection of the sternoclavicular joint as the gold standard treatment. Closure of the wound using muscle flap seems to adequately treat this problem without any major untoward events.
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Affiliation(s)
- Barkat Ali
- Surgery, University of New Mexico Health Sciences Center, Albuquerque, USA
| | - Venus Barlas
- Surgery, University of New Mexico School of Medicine, Albuquerque, USA
| | - Anil K Shetty
- Surgery, University of New Mexico School of Medicine, Albuquerque, USA
| | - Christopher Demas
- Surgery, University of New Mexico School of Medicine, Albuquerque, USA
| | - Jess D Schwartz
- Surgery, University of New Mexico School of Medicine, Albuquerque, USA
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15
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Tasnim S, Shirafkan A, Okereke I. Diagnosis and management of sternoclavicular joint infections: a literature review. J Thorac Dis 2020; 12:4418-4426. [PMID: 32944355 PMCID: PMC7475584 DOI: 10.21037/jtd-20-761] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The sternoclavicular joint (SCJ) is anatomically and clinically significant considering its proximity to important neuro-vascular structures like the subclavian vessels and the phrenic nerve. Infections of this joint masquerade multiple disorders, delay diagnosis and spread to the bone and deep tissues. There is no standardized workup and treatment protocol for sternoclavicular joint infections (SCJI) as defined in literature. Here, we review the existing literature to understand the current knowledge of the diagnosis and treatment of SCJI. We searched English publications in PubMed and included clinical trials, case reports, case series, retrospective cohort studies, literature and systematic reviews after excluding non-infectious etiology of SCJ pathologies. There are many risk factors for SCJI, such as immunocompromised status, intravenous drug use, trauma and arthropathies. But a large percentage of patients with disease have none of these risk factors. SCJIs can present with fever, joint swelling, immobility, and rarely with vocal cord palsy or dysphagia. While Staphylococcus aureus causes over 50% of SCJI cases, other pathogens such as Pseudomonas and Mycobacterium are frequently seen. When diagnosed early, the infection can be medically managed with antibiotics or joint aspirations. Most cases of SCJI, however, are diagnosed after extensive spread to soft tissue and bones requiring en-bloc resection with or without a muscle flap. Complications of undertreatment can range from simple abscess formation to mediastinitis, even sepsis. SCJIs are rare but serious infections prompting early detection and interventions. Most cases of SCJI treated adequately show complete resolution in months while retaining maximum functionality. Key features of proper healing include aggressive physiotherapy to prevent adhesive shoulder capsulitis and decreased range of motion.
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Affiliation(s)
- Sadia Tasnim
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Ali Shirafkan
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Ikenna Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
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16
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Bayfield NGR, Wang E, Larbalestier R. Medical and conservative surgical management of bacterial sternoclavicular joint septic arthritis: a case series. ANZ J Surg 2020; 90:1754-1759. [DOI: 10.1111/ans.16019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/28/2020] [Accepted: 05/14/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Nicholas G. R. Bayfield
- Department of Cardiothoracic Surgery and Transplantation Fiona Stanley Hospital Perth Western Australia Australia
| | - Edward Wang
- Department of Cardiothoracic Surgery and Transplantation Fiona Stanley Hospital Perth Western Australia Australia
| | - Robert Larbalestier
- Department of Cardiothoracic Surgery and Transplantation Fiona Stanley Hospital Perth Western Australia Australia
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Fornwalt BE, Goosmann M, Reynolds S, Bunevich JD. Sternoclavicular joint septic arthritis presenting as cervical abscess and subcutaneous emphysema: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20902874. [PMID: 32110404 PMCID: PMC7000855 DOI: 10.1177/2050313x20902874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 12/31/2019] [Indexed: 11/23/2022] Open
Abstract
Sternoclavicular joint septic arthritis results from hematogenous spread of a
bacterial infection, usually in the immunocompromised. It commonly presents as a
chest wall abscess. Cervical abscess resulting from sternoclavicular joint
septic arthritis is a rare complication with only one reported case in the
English literature. We describe a case of sternoclavicular joint septic
arthritis in an elderly diabetic adult with cervical abscess as initial
presentation.
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Affiliation(s)
- Brandon E Fornwalt
- Department of Otolaryngology, Bon Secours Mercy Health-St. Elizabeth Boardman Hospital, Boardman, OH, USA
| | | | - Stephen Reynolds
- Department of Otolaryngology, Bon Secours Mercy Health-St. Elizabeth Boardman Hospital, Boardman, OH, USA
| | - Jared D Bunevich
- Department of Otolaryngology, Bon Secours Mercy Health-St. Elizabeth Boardman Hospital, Boardman, OH, USA
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18
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Ali B, Shetty A, Qeadan F, Demas C, Schwartz JD. Sternoclavicular Joint Infections: Improved Outcomes With Myocutaneous Flaps. Semin Thorac Cardiovasc Surg 2020; 32:369-376. [DOI: 10.1053/j.semtcvs.2019.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/14/2019] [Indexed: 11/11/2022]
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19
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Khan TMA, Siddiqui AH, Ansari Y, Ansari SA, Siddiqui F. Sternoclavicular Joint Septic Arthritis and Anterior Mediastinal Mass in a Young Athlete: Possible Immune-modulatory Effect of Growth Hormone. Cureus 2019; 11:e6155. [PMID: 31890364 PMCID: PMC6913913 DOI: 10.7759/cureus.6155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Septic arthritis of sternoclavicular joint (SCJ) is a rare disease, however, not uncommon in patients who abuse intravenous drugs. It can present with a wide range of manifestations that can pose diagnostic challenges, which can result in a delay in diagnosis and treatment. Over the last few decades, there is a surge in the use of nonprescription recombinant human growth hormone (rhGH) by the young healthy population and athletes for its purported ergogenic effects. Furthermore, we lack quantitative information about the adverse effects of the chronic use of rhGH in a healthy population due to the scarcity of epidemiological data. We are reporting a case of a young male athlete who was chronically using the subcutaneous rhGH formulation to build lean body mass, and presented with septic arthritis of right SCJ due to methicillin-sensitive Staphylococcus aureus (MSSA) complicated by a necrotic inflammatory response involving the mediastinum which infiltrated the apical lung parenchyma. The clinical presentation masqueraded as the mediastinal mass raising the suspicion of mediastinal malignancy. Histological analysis of the tissue of SCJ and mediastinal area revealed no malignant cells but a lymphocyte-predominant inflammatory response with germinal centers was observed, which was an atypical response to MSSA bacterial infection. We have reviewed the literature to elucidate the immune-modulatory effect of rhGH, as the chronic use of rhGH by our patient probably has contributed to an atypical immune response to MSSA. The patient was treated with an extended duration of parenteral antibiotics and multiple incision and debridements to achieve complete resolution of infection over the next six months. This is a unique case of septic arthritis of right SCJ in a patient on chronic subcutaneous rhGH which masqueraded as a mediastinal mass raising concern of malignancy; moreover, it highlights the probable immune-modulatory role of rhGH which instigated an atypical immune response to MSSA infection.
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Affiliation(s)
| | - Abdul Hasan Siddiqui
- Pulmonary and Critical Care Medicine, Staten Island University Hospital / Northwell Health, Staten Island, USA
| | - Yusra Ansari
- Internal Medicine, Rawalpindi Medical College, Rawalpindi, PAK
| | - Saad Ali Ansari
- Internal Medicine, Pakistan Institute of Medical Sciences, Islamabad, PAK
| | - Faraz Siddiqui
- Pulmonary and Critical Care Medicine, Robert Packer Hospital, Sayre, USA
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20
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von Glinski A, Yilmaz E, Rausch V, Koenigshausen M, Schildhauer TA, Seybold D, Geßmann J. Surgical management of sternoclavicular joint septic arthritis. J Clin Orthop Trauma 2019; 10:406-413. [PMID: 30828216 PMCID: PMC6383133 DOI: 10.1016/j.jcot.2018.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/10/2018] [Accepted: 05/07/2018] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Infections of the sternoclavicular joint (SCJ) account for less than 1% of all joint infections. There are no standardized diagnostic and therapeutic algorithms defined in literature. This study intended to report the risk factors, the bacterial spectrum, the extent and localization and the clinical outcome of SCJ infections. PATIENTS AND METHODS We retrospectively reviewed the medical charts of 13 patients (8 men, five women, mean age 37.6 years) with SCJ infections between Januray 1st 2008 and October 30th 2015 for clinical parameters and radiological studies. All patients were interviewed during their follow-up along with clinical examination and assessing the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). RESULTS Nine patients presented with local chest pain and swelling; in 4 patients, the prevalent symptom was pain without local signs of inflammation. Full blood count revealed a mean leukocytosis of 15 × 109 L and a mean CRP of 21.0 mg/dl. Approximately 61.5% reported known diabetes mellitus. 10 patients presented an involvement of surrounding structures. All patients received a preoperativ CT scan. Each patient was treated via SCJ resection without intraoperative complications. Primary wound closure was possible in all cases. The mean follow-up was 95 days. Wound culture revealed Staphylococcus aureus in all patients. Pathological examination affirmed acute osteomyelitis in 7 patients. Four patients required the intensive care of which 2 patients died from septic shock. Recurrent infection was encountered in 3 patients who underwent revision surgery. Mean DASH Score was 18.7. CONCLUSION CT should be routinely obtained to recognize the possible extends to the surrounding structures. SCJ resection can result in satisfactory clinical results and should be considered in cases of extended infections including the surrounding structures. Empiric antibiotic coverage should contain cephalosporin or extended-spectrum penicillin. Inappropriate or less-invasive surgical procedures may cause recurrencent infections, especially in cases of osteomyelitis.
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Affiliation(s)
- Alexander von Glinski
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany,Corresponding author at: Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany.
| | - Emre Yilmaz
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany,Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States
| | - Valentin Rausch
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Matthias Koenigshausen
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Dominik Seybold
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Jan Geßmann
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany,Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States
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21
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Sharif KF, Baik FM, Jategaonkar AA, Khorsandi AS, Urken ML. Septic arthritis of the sternoclavicular joint: A unique late complication after tracheostomy. Am J Otolaryngol 2018; 39:646-648. [PMID: 29776683 DOI: 10.1016/j.amjoto.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/10/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Septic arthritis of the sternoclavicular joint is a rare infection associated with significant morbidity and mortality. Several risk factors for septic arthritis have been reported in the literature ranging from immunodeficiency to intravenous drug use. CASE PRESENTATION A 63-year-old male previously treated for synchronous squamous cell carcinomas of the epiglottis and floor of mouth presented with tenderness and swelling of the sternoclavicular joint two months after tracheostomy decannulation. Computed tomography and bone scans confirmed the diagnosis of septic arthritis of the sternoclavicular joint. The patient's clinical course, surgical treatment, and management considerations are discussed here. CONCLUSION Septic arthritis of the SCJ is a rare but serious infection. Once diagnosed, septic arthritis of the SCJ should be promptly treated to prevent further morbidity and mortality.
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Edwin J, Ahmed S, Verma S, Tytherleigh-Strong G, Karuppaiah K, Sinha J. Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies. EFORT Open Rev 2018; 3:471-484. [PMID: 30237905 PMCID: PMC6134883 DOI: 10.1302/2058-5241.3.170078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The sternoclavicular joint (SCJ) is an integral part of the shoulder girdle that connects the upper limb to the axial skeleton. Swelling of the SCJ is commonly due to trauma, degeneration, infections and other disease processes that affect synovial joints. This review also focuses on uncommon conditions that could affect the SCJ, including SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome, Friedrich’s disease and Tietze syndrome. The scope of this review is limited to the analysis of the current evidence on the various conditions affecting the SCJ and also to provide an algorithm to manage these conditions.
Cite this article: EFORT Open Rev 2018;3:471-484. DOI: 10.1302/2058-5241.3.170078
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Affiliation(s)
| | - Shahbaz Ahmed
- Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK
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Masmoudi K, Elleuch E, Akrout R, Feki A, Ezzeddine M, Fourati H, Lahiani D, Ben Jemaâ M, Baklouti S. Bilateral septic arthritis of the sternoclavicular joint complicating infective endocarditis: a case report. J Med Case Rep 2018; 12:205. [PMID: 29973288 PMCID: PMC6033282 DOI: 10.1186/s13256-018-1709-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Septic arthritis is an infectious disease that commonly affects weight-bearing or proximal joints such as the knee and the hip. The sternoclavicular joint is an unusual site of this entity. It usually occurs in patients with diabetes mellitus, intravenous drug abusers, or those with rheumatoid arthritis. Analysis of the previous literature showed few articles and these described essentially cases of unilateral presentation. CASE PRESENTATION We report a rare case of a bilateral septic arthritis of the sternoclavicular joint sustained by a 71-year-old Tunisian woman whose medical history was significant for methicillin-resistant Staphylococcus aureus infective endocarditis 6 months ago. Imaging investigations revealed destruction of the medial extremities of her two clavicles and bilateral collections in the soft tissues around her sternoclavicular joints. She was treated successfully by needle aspiration drainage combined with a 12-week antibiotherapy. CONCLUSIONS Bilateral septic arthritis of the sternoclavicular joint is an extremely rare entity, with a paucity of literature. Only early diagnosis, which is obtained from the culture of the joint fluid using needle aspiration, allows satisfactory functional outcome and a good prognosis. Osteoarticular infections should be considered in patients with recent infective endocarditis in cases of fever recurrence.
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Affiliation(s)
- Karim Masmoudi
- Medicine Faculty of Sousse, Mohamed Karoui Avenue, zip code 4000, Sousse, Tunisia.
| | - Emna Elleuch
- Infectious Diseases Department, Hédi Chaker University Hospital, El-Aïn Street Km 0,5, zip code 3029, Sfax, Tunisia
| | - Rim Akrout
- Rheumatology Department, Hédi Chaker University Hospital, El-Aïn Street Km 0,5, zip code 3029, Sfax, Tunisia
| | - Afef Feki
- Rheumatology Department, Hédi Chaker University Hospital, El-Aïn Street Km 0,5, zip code 3029, Sfax, Tunisia
| | - Mariam Ezzeddine
- Rheumatology Department, Hédi Chaker University Hospital, El-Aïn Street Km 0,5, zip code 3029, Sfax, Tunisia
| | - Hela Fourati
- Rheumatology Department, Hédi Chaker University Hospital, El-Aïn Street Km 0,5, zip code 3029, Sfax, Tunisia
| | - Dorra Lahiani
- Infectious Diseases Department, Hédi Chaker University Hospital, El-Aïn Street Km 0,5, zip code 3029, Sfax, Tunisia
| | - Mounir Ben Jemaâ
- Infectious Diseases Department, Hédi Chaker University Hospital, El-Aïn Street Km 0,5, zip code 3029, Sfax, Tunisia
| | - Sofiène Baklouti
- Rheumatology Department, Hédi Chaker University Hospital, El-Aïn Street Km 0,5, zip code 3029, Sfax, Tunisia
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24
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Alves S, Rodrigues L, Santos M, Moreira D. Kingella kingae sternoclavicular osteoarthritis. BMJ Case Rep 2018; 2018:bcr-2017-223213. [PMID: 29507023 DOI: 10.1136/bcr-2017-223213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Sternoclavicular arthritis is an unusual osteoarticular infection and can be associated with severe complications. Cases in a paediatric population are infrequently reported, making this approach challenging. Kingella kingae is an agent of increasing recognition in paediatric invasive infections, principally below 2 years of age. A case of K. kingae osteoarthritis in a 17-month-old child is described with a review of the literature.
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Affiliation(s)
- Sérgio Alves
- Paediatric Department, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Lúcia Rodrigues
- Paediatric Department, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Mafalda Santos
- Paediatric Orthopedics Department, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Diana Moreira
- Paediatric Department, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
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Murga A, Copeland H, Hargrove R, Wallen JM, Zaheer S. Treatment for sternoclavicular joint infections: a multi-institutional study. J Thorac Dis 2017; 9:1503-1508. [PMID: 28740662 DOI: 10.21037/jtd.2017.05.76] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Sternoclavicular joint (SCJ) infections are rare and difficult to manage. Surgery is necessary for treatment. METHODS A retrospective chart review of the university hospital and Veterans Administration (VA) hospitals of all patients treated for SCJ infections since 2001 was conducted. Fifteen [15] patients were identified and evaluated for the types of infections, risk factors, treatments and survival. RESULTS All 15 patients were symptomatic including: pain [13], erythema [9], purulent drainage [3], fever greater than 38.3 °C [2], and leukocytosis [9]. The associated medical problems included: diabetes mellitus (DM), hypertension (HTN) and renal failure. All patients underwent intraoperative joint resection. Sixty-seven percent (67%) of intraoperative wound cultures grew staphylococcus aureus. Fourteen patients were discharged on intravenous antibiotics. The follow-up ranged between 1 week-11 months. Thirteen patients are currently alive without infection. Two patients died: 1 of sepsis and 1 of unknown causes after discharge. CONCLUSIONS Symptomatic SCJ infections require surgical intervention. The most common organism was staphylococcus aureus.
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Affiliation(s)
- Allen Murga
- Department of Thoracic and Cardiovascular Surgery, Loma Linda University, Loma Linda, CA 92354, USA
| | - Hannah Copeland
- Department of Thoracic and Cardiovascular Surgery, Loma Linda University, Loma Linda, CA 92354, USA
| | - Rachel Hargrove
- Department of Thoracic and Cardiovascular Surgery, Loma Linda University, Loma Linda, CA 92354, USA
| | - Jason M Wallen
- Department of Thoracic and Cardiovascular Surgery, Loma Linda University, Loma Linda, CA 92354, USA
| | - Salman Zaheer
- Department of Thoracic and Cardiovascular Surgery, Loma Linda University, Loma Linda, CA 92354, USA
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26
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Tanaka Y, Kato H, Shirai K, Nakajima Y, Yamada N, Okada H, Yoshida T, Toyoda I, Ogura S. Sternoclavicular joint septic arthritis with chest wall abscess in a healthy adult: a case report. J Med Case Rep 2016; 10:69. [PMID: 27015841 PMCID: PMC4808294 DOI: 10.1186/s13256-016-0856-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 03/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Septic arthritis of the sternoclavicular joint is rare. It can be associated with serious complications such as osteomyelitis, chest wall abscess, and mediastinitis. In this report, we describe a case of an otherwise healthy adult with septic arthritis of the sternoclavicular joint with chest wall abscess. CASE PRESENTATION A 68-year-old Japanese man presented to our hospital complaining of pain and erythema near the right sternoclavicular joint. Despite 1 week of oral antibiotics, his symptoms did not improve. Computed tomography revealed an abscess with air around the right pectoralis major muscle. After being transferred to a tertiary hospital, emergency surgery was performed. Operative findings included necrotic tissue around the right sternoclavicular joint and sternoclavicular joint destruction, which was debrided and packed open. Methicillin-susceptible Staphylococcus aureus was identified in blood and wound cultures. Negative pressure wound therapy and hyperbaric oxygen therapy were performed for infection control and wound healing. The patient's general condition improved, and good granulation tissue developed. The wound was closed using a V-Y flap on hospital day 48. The patient has been free of relapse for 3 years. CONCLUSIONS Septic arthritis of the sternoclavicular joint is an unusual infection, especially in otherwise healthy adults. Because it is associated with serious complications such as chest wall abscess, prompt diagnosis and appropriate treatment are required.
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Affiliation(s)
- Yoshihito Tanaka
- Department of Emergency and Disaster Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
| | - Hisaaki Kato
- Department of Emergency and Disaster Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
| | - Kunihiro Shirai
- Department of Emergency and Disaster Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
| | - Yasuhiro Nakajima
- Department of Emergency and Disaster Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
| | - Noriaki Yamada
- Department of Emergency and Disaster Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
| | - Hideshi Okada
- Department of Emergency and Disaster Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
| | - Takahiro Yoshida
- Department of Emergency and Disaster Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
| | - Izumi Toyoda
- Department of Emergency and Disaster Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
| | - Shinji Ogura
- Department of Emergency and Disaster Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
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27
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Simplified Method for Treating Osteomyelitis of the Sternoclavicular Joint. Ann Thorac Surg 2016; 101:1211-2. [PMID: 26897216 DOI: 10.1016/j.athoracsur.2015.08.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/04/2015] [Accepted: 08/07/2015] [Indexed: 11/20/2022]
Abstract
Osteomyelitis of the sternoclavicular joint is a rare yet challenging problem. It is commonly treated by resection and a muscle flap. We report a case that was treated with single-stage resection of both the sternoclavicular joint and part of the sternum followed by implantation of calcium sulfate beads impregnated with antibiotics and primary closure without a muscle flap. A single-stage debridement with resection for osteomyelitis of the sternoclavicular joint and primary closure with calcium sulfate beads impregnated with antibiotics may be an option when dealing with this difficult clinical problem.
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28
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Jamil F, Hussain K. Vocal cord palsy as a presenting feature of sternoclavicular joint septic arthritis. J Surg Case Rep 2015; 2015:rju147. [PMID: 25583908 PMCID: PMC4289859 DOI: 10.1093/jscr/rju147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Sternoclavicular joint septic arthritis (SSA) is rare and often difficult to manage condition. The sternoclavicular joint is an unusual site of septic arthritis in healthy persons, but may be commonly involved in intravenous drug users, primary or secondary immunosuppressive disorders, infections or the presence of infected central lines. After thorough literature search, no cases have yet been reported on SSA leading to vocal cord palsy. The following case describes a male patient who presented to hospital with left vocal cord palsy and symptoms consistent with aero-digestive tract malignancy. Radiological examination and subsequent response to treatment demonstrated the only causative pathology to be an ipsilateral septic sternoclavicular joint.
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Affiliation(s)
- Fahad Jamil
- Department of Oral and Maxillofacial Surgery, St George's Healthcare NHS Trust, London, UK
| | - Khalid Hussain
- Department of Otolaryngology, University Hospital Birmingham, Birmingham, UK
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Treatment of sternoclavicular joint osteomyelitis with debridement and delayed resection with muscle flap coverage improves outcomes. Surg Res Pract 2014; 2014:747315. [PMID: 25379557 PMCID: PMC4208504 DOI: 10.1155/2014/747315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 02/07/2014] [Accepted: 02/09/2014] [Indexed: 12/20/2022] Open
Abstract
The objective of this study was to evaluate the efficacy of various treatment options for sternoclavicular joint osteomyelitis. We evaluated patients with a diagnosis of sternoclavicular joint osteomyelitis, treated at our hospital from 2002 to 2012. Four treatment options were compared. Three out of twelve patients were successfully cured with antibiotics alone (25%). Debridement with or without negative pressure therapy was successful for one of three patients (33%). Simultaneous debridement, bone resection, and muscle flap coverage of the acquired defect successfully treated one of two patients (50%). Debridement with delayed bone resection and muscle flap coverage was successful in five of five patients (100%). Osteomyelitis of the sternoclavicular joint is a rare disease that has become more prevalent in recent years and can be associated with increasing use of long-term indwelling catheters. Initial debridement with delayed bone resection and pectoralis major muscle flap coverage can effectively treat sternoclavicular joint osteomyelitis.
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30
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Doyle MP, Jennings SB, Horton MDA. Delayed surgical intervention of sternoclavicular joint infection with increased complications. ANZ J Surg 2013; 85:193-5. [PMID: 24164960 DOI: 10.1111/ans.12414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Mathew P Doyle
- Cardiothoracic Surgery, St George Hospital, Kogarah, New South Wales, Australia
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31
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Fry D, Boyle S. Sternoclavicular joint septic arthritis: an interesting lesson in clinical anatomy. BMJ Case Rep 2013; 2013:bcr-2013-200673. [PMID: 24105386 DOI: 10.1136/bcr-2013-200673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An otherwise healthy 45-year-old man presented to our emergency department holding his left arm in abduction and external rotation. He reported pain in his left shoulder and chest for the preceding 10 days that had become much worse over the last 48 h and was eased only by holding his arm in this position. The CT of the chest revealed soft tissue swelling around the left sternoclavicular joint consistent with sternoclavicular joint septic arthritis with significant inflammatory involvement of the medial component of the left pectoralis major muscle. The patient was taken to theatre for washout of the left sternoclavicular joint and is currently recovering well at home on intravenous antibiotics.
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Affiliation(s)
- Damian Fry
- Department of Emergency Medicine, Ipswich Hospital, Ipswich, Queensland, Australia
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32
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Sternoclavicular joint infection: classification of resection defects and reconstructive algorithm. Arch Plast Surg 2012; 39:643-8. [PMID: 23233891 PMCID: PMC3518009 DOI: 10.5999/aps.2012.39.6.643] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 07/10/2012] [Accepted: 07/17/2012] [Indexed: 12/02/2022] Open
Abstract
Background Aggressive treatment of sternoclavicular joint (SCJ) infection involves systemic antibiotics, surgical drainage and resection if indicated. The purpose of this paper is to describe a classification of post resectional SCJ defects and highlight our reconstructive algorithm. Defects were classified into A, where closure was possible often with the aid of topical negative pressure dressing; B, where parts of the manubrium, calvicular head, and first rib were excised; and C, where both clavicular, first ribs and most of the manubrium were resected. Methods Twelve patients (age range, 42 to 72 years) over the last 8 years underwent reconstruction after SCJ infection. There was 1 case of a type A defect, 10 type B defects, and 1 type C defect. Reconstruction was performed using the pectoralis major flap in 6 cases (50%), the latissimus dorsi flap in 4 cases (33%), secondary closure in 1 case and; the latissimus and the rectus flap in 1 case. Results All wounds healed uneventfully with no flap failure. Nine patients had good shoulder motion. Three patients with extensive clavicular resection had restricted shoulder abduction and were unable to abduct their arm past 90°. Internal and external rotation were not affected. Conclusions We highlight our reconstructive algorithm which is summarised as follows: for an isolated type B SCJ defect we recommend the ipsilateral pectoralis major muscle for closure. For a type C bilateral defect, we suggest the latissimum dorsi flap. In cases of extensive infection where the thoracoacromial and internal mammary vessels are thrombosed, the pectoralis major and rectus abdominus cannot be used; and the latissimus dorsi flap is chosen.
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A case of strenoclavicular septic arthritis with mediastinitis managed conservatively and literature review. Indian J Thorac Cardiovasc Surg 2012. [DOI: 10.1007/s12055-012-0148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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