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Millet-Herrera JL, Pérez-Navarrete A, Echeverría-Ortegón E, Alejos-Gómez R, Mendez-Dominguez N. Figure-of-Eight Cerclage With High-Resistance Sutures Plus InternalBrace as Treatment for Posterior Dislocation of the Sternoclavicular Joint: A Case Report. Cureus 2024; 16:e64400. [PMID: 39130940 PMCID: PMC11317032 DOI: 10.7759/cureus.64400] [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: 07/11/2024] [Indexed: 08/13/2024] Open
Abstract
The sternoclavicular joint dislocation is a very infrequent injury that can put the patient's life at risk if it is not diagnosed and treated properly. This can present as an anterior or posterior dislocation, the latter being less common and more dangerous due to its proximity to visceral structures of the thoracic cavity. Herein, we present the case of a 19-year-old male athlete diagnosed with a posterior dislocation of the right sternoclavicular joint due to indirect trauma during a soccer match, who was successfully treated with a figure-of-eight cerclage with high-resistance sutures plus an InternalBrace technique. After recovery, he has been able to get back to sports with a complete range of motion and experiencing no instability after a two-year follow-up. Figure-of-eight cerclage with high-resistance sutures plus an InternalBrace could be a good technique for surgical treatment of this rare injury, especially in young and physically active patients.
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Affiliation(s)
| | | | | | | | - Nina Mendez-Dominguez
- Research and Learning, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan, Merida, MEX
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2
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Ingoe HMA, Mohammed K, Malone AA, Beadle G, Sharpe T, Cockfield A, Lloyd R, Singh H, Colgan F. Traumatic posterior sternoclavicular joint dislocation - Current aspects of management. Injury 2023; 54:110983. [PMID: 37634999 DOI: 10.1016/j.injury.2023.110983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/19/2023] [Accepted: 08/05/2023] [Indexed: 08/29/2023]
Abstract
The posterior sternoclavicular joint dislocation is a rare and potentially life-threatening injury, as massive haemorrhage can occur at the time of trauma, during reduction manoeuvres and drilling. These injuries are rare and a collective experience of managing them is of paramount importance. We present our multidisciplinary experience of managing several of these injuries in our centre, with learning points we have identified. Assessment should include Computerised Tomography Angiography (CTA) to assess the anatomy of the joint including the proximity to the underlying innominate vein and to identify any bleeding. Both closed reduction and open reconstruction have the potential for massive haemorrhage which can be controlled successfully with direct access to the underlying vessel. We recommend that all reductions should be performed in the presence of a cardiothoracic surgeon who can gain vascular control in the head, neck, and thorax. In specific high-risk cases, pre-emptive venous catheterisation can also be considered. We recommend that a discussion and rehearsal for intra-operative bleeding should be undertaken with the whole theatre team, with roles assigned pre-emptively and to allow identification of any deficiencies in staff expertise or equipment. Of the five recent cases managed in our centre one patient had a closed reduction and four had open reductions. Success of closed reductions within 48 h is high and these can be attempted up to 10 days after injury. Our patient undergoing closed reduction had a favourable outcome and returned to professional rugby at five months. Open reduction was performed in a physeal fracture as there was a delay to surgery and callus had begun to form and had the potential to adhere to the underlying vessel. In this case we performed open reduction and stabilised with tunnelled suture fixation. Our preferred method of reconstruction uses a palmaris graft with internal figure of eight bracing. One patient had a subsequent fracture of the medial clavicle around the drill holes that healed without further intervention. Despite good reduction and stability achieved following palmaris reconstructions, two patients are experiencing ongoing symptoms of globus and one with voice change without any objective underlying cause.
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Affiliation(s)
- Helen M A Ingoe
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand.
| | - Khalid Mohammed
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Alex A Malone
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Gordon Beadle
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Thomas Sharpe
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Allen Cockfield
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Richard Lloyd
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Harsh Singh
- Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand; Dept of Cardiothoracic Surgery, Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Frances Colgan
- Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand; Department of Interventional Radiology, Christchurch Hospital, Christchurch, 8011 New Zealand
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Jessen M, Schnetzke M, Studier-Fischer S, Grützner PA, Gühring T, Porschke F. Morphologic Alterations of the Sternoclavicular Joint following Ipsilateral Clavicle Fractures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15011. [PMID: 36429729 PMCID: PMC9690708 DOI: 10.3390/ijerph192215011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
RATIONALE To our knowledge, no study has investigated concomitant injuries of the sternoclavicular joint (SCJ) in acute clavicle fractures. The purpose of this study was to determine the effect of an ipsilateral clavicle fracture on the SCJ in a systematic computer tomography (CT) morphologic evaluation. METHODS CT scans in the axial and coronal plane of 45 consecutive patients with clavicle fractures were retrospectively analyzed. The scans were assessed regarding anatomic congruence of bilateral SCJs-joint space width (JSW); the position of bilateral medial clavicles (PC); and the non-fusion of epiphyses, arthritis, calcifications, and intra-articular gas. RESULTS The mean SCJ JSW was significantly different in the coronal (cJSW; 8.70 mm ± 2.61 mm in affected vs. 7.63 mm ± 2.58 mm in non-affected side; p = 0.001) and axial plane (aJSW; 9.40 mm ± 2.76 mm in affected vs. 9.02 ± 2.99 in non-affected SCJs; p = 0.044). The position of the medial clavicle showed a significant difference in the coronal plane (cPC; 14.31 mm ± 3.66 mm in the affected vs. 13.49 ± 3.34 in the non-affected side; p = 0.011), indicating a superior shift. CONCLUSION Acute clavicle fractures may be associated with an enlargement of the ipsilateral SCJ space width and a superior shift of the proximal clavicle. Both morphologic alterations could indicate concomitant injuries of the SCJ as well as a potential increase in the risk of SCJ instability.
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Affiliation(s)
- Malik Jessen
- Department of Trauma Surgery, Clinic Rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Marc Schnetzke
- German Joint Center Heidelberg, ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115 Heidelberg, Germany
| | - Stefan Studier-Fischer
- BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen, Germany
| | - Paul Alfred Grützner
- BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen, Germany
| | - Thorsten Gühring
- Orthopedic Clinic Paulinenhilfe, Diakonieklinikum Stuttgart, Rosenbergstr. 38, 70176 Stuttgart, Germany
| | - Felix Porschke
- BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen, Germany
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Jacob E, Herbst E, Raschke MJ, Katthagen JC. Bipolar clavicular instability – open reduction and tape augmentation of both joints: A case report. Trauma Case Rep 2022; 42:100739. [DOI: 10.1016/j.tcr.2022.100739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 11/26/2022] Open
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Al-Attar PM, Ryan BT, Wottowa CE. O-arm use in the surgical management of pediatric posterior sternoclavicular joint injury: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:554-558. [PMID: 37588450 PMCID: PMC10426590 DOI: 10.1016/j.xrrt.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Paul M. Al-Attar
- Division of Orthopedic Surgery, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Benjamin T. Ryan
- Division of Orthopedic Surgery, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Christopher E. Wottowa
- Division of Orthopedic Surgery, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
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Han Y, Cho EH, Martinez A, Martineau PA. Sternoclavicular Joint Reconstruction with Semitendinosus Allograft and Suture Anchors after Recurrent Posterior Dislocation in a Professional North American Football Player. Open Orthop J 2022. [DOI: 10.2174/18743250-v16-e2208180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background:
Posterior sternoclavicular joint dislocations are an extremely rare but potentially life-threatening injury that can occur in sports. A variety of surgical procedures have been proposed, but there is no consensus on the treatment of choice. It is also largely unknown if a safe return to high-risk sports is possible.
Case Presentation:
We present a case of a posterior sternoclavicular joint dislocation in a 22-year-old male professional North American football player who had a recurrent irreducible posterior dislocation after initial injury management by closed reduction. The patient’s desire to return to football presented unique challenges to management. His sternoclavicular joint was subsequently reconstructed with semitendinosus allograft in a figure-of-eight augmented with suture anchors. After recovery, he returned to play as a running back in professional football symptom-free.
Conclusion:
Our patient's successful return to playing professional football after the sternoclavicular joint reconstruction suggests that this should be considered an effective treatment option when managing posterior sternoclavicular dislocation in high level contact sports players.
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Gutiérrez-Zúñiga D, Valbuena F, Largacha M. Sternoclavicular reconstruction with "sternal docking" technique and suture tape augmentation in an elite gymnast: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:419-423. [PMID: 37588860 PMCID: PMC10426618 DOI: 10.1016/j.xrrt.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
| | - Felipe Valbuena
- Shoulder and Elbow Surgery, Pontificia Universidad Javeriana, Clínica del Country, Bogotá, Colombia
| | - Mauricio Largacha
- Shoulder and Elbow Surgery, Pontificia Universidad Javeriana, Clínica del Country, Bogotá, Colombia
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Qu Y, Xie X, Zhou W, Xia T, Cao F, Mi B, Xiong Y, Ye Z, Liu G. Operative treatment outcomes of anterior sternoclavicular joint dislocation using two experimental methods - an acromioclavicular joint hook plate versus a locking plate: a retrospective study. BMC Musculoskelet Disord 2022; 23:350. [PMID: 35410232 PMCID: PMC8996669 DOI: 10.1186/s12891-022-05293-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/14/2022] [Indexed: 09/07/2024] Open
Abstract
Background We aimed to compare the intraoperative and early postoperative clinical outcomes of using an acromioclavicular joint hook plate (AJHP) versus a locking plate (LP) in the treatment of anterior sternoclavicular joint dislocation. Methods Seventeen patients with anterior sternoclavicular joint dislocation were retrospectively analyzed from May 2014 to September 2019. Six patients were surgically treated with an AJHP, and 11 were surgically treated with an LP. Five male and one female patients composed the AJHP group, and nine male and two female patients composed the LP group. The mean age of all patients was 49.5 years. Results Reduction and fixation were performed with AJHP or LP in all 17 patients. The mean operative blood loss, operative time, and length of incision in the AJHP group were significantly better than those in the LP group. Shoulder girdle movement of the AJHP group was significantly better than that of the LP group. Conclusions This study revealed that AJHP facilitated glenohumeral joint motion, reduced the risk of rupture of mediastinal structures, required a shorter incision, and had lesser blood loss and a shorter duration of operation compared with LP. However, some deficiencies require further improvement. Supplementary information The online version contains supplementary material available at 10.1186/s12891-022-05293-x.
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Affiliation(s)
- Yanzhen Qu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Xudong Xie
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Wu Zhou
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Tian Xia
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Faqi Cao
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Bobin Mi
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Yuan Xiong
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Zhewei Ye
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Guohui Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China.
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Fandridis E, Koutserimpas C, Raptis K, Antonopoulos D, Zampeli F, Gakidis I. Anterior dislocation of sternoclavicular joint: A novel surgical technique. Injury 2022; 53:1562-1567. [PMID: 34740440 DOI: 10.1016/j.injury.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Anterior 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 METHODS Patients 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. RESULTS Seven 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. CONCLUSION The 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.
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Affiliation(s)
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Greece.
| | - Konstantinos Raptis
- Hand-Upper Limb & Microsurgery Department, Hospital "KAT", Athens, Greece; Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Greece
| | | | - Frantzeska Zampeli
- Hand-Upper Limb & Microsurgery Department, Hospital "KAT", Athens, Greece
| | - Ioannis Gakidis
- Department of Thoracic Surgery, Hospital "KAT", Athens, Greece
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10
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Complications after sternoclavicular surgery. J Shoulder Elbow Surg 2021; 30:e392-e398. [PMID: 33038497 DOI: 10.1016/j.jse.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 09/06/2020] [Accepted: 09/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Sternoclavicular joint (SCJ) pathologies such as instability are rare; therefore, SCJ surgery is performed infrequently. Complications of these surgeries can be devastating. This study evaluated complications, and particularly infections, after SCJ surgery. METHODS A retrospective cohort of 68 patients who underwent SCJ surgery with a minimum follow-up of 1 year was reviewed. Patients' characteristics, intraoperative, and postoperative complications were retrieved. In case of a reoperation, relevant data from the reoperation and microbiological findings were collected. RESULTS Twenty-two men and 46 women with a mean age of 37.5 years (range, 13-70 years) were analyzed. A complication occurred in 26 of 68 patients (38.2%). In 16 patients (23.5%), this was an infection. Cutibacterium acnes was the pathogen in 14 of these infections. Infection occurred more often in men than in women (P = .02). A total of 26 reoperations were performed in our cohort: 14 due to clinical signs of infection, 9 due to instability, 1 due to complaints of SCJ osteoarthritis, and 2 due to other causes. CONCLUSION Complications after SCJ surgery occur more often than previously described. C. acnes infections are often seen. When left untreated, these complications can lead to persistent complaints or recurrent instability due to failure of reconstruction. Therefore, it is of utmost importance to identify infections at an early stage, or better, to prevent them. The use of benzoyl peroxide gel preoperatively seems effective in reducing early C. acnes infections in this type of surgery.
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Calderazzi F, Menozzi M, Valenti P, Colacicco A, Bastia P, Pogliacomi F, Ceccarelli F. A rare case of complicated pure posterior sternoclavicular dislocation in a young athlete. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020015. [PMID: 33559637 PMCID: PMC7944707 DOI: 10.23750/abm.v91i14-s.10949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/24/2022]
Abstract
Sternoclavicular joint dislocation (SCJD) is a rare injury, generally classified in anterior and posterior. The posterior SCJD is very infrequent yet potentially associated with life-threatening complications. In patients with unfused medial clavicle physis, SCJD can be associated with fracture-dislocation (Salter type I or II). We hereby present the case of a 12-year-old basketball player with severe pain in sternoclavicular region and arising dysphagia after a fall and tackle by another player. A SCJ injury was hypothesised and the CT scan detected the presence of a true posterior SCJD with no associated fracture, which was also confirmed during open reduction. As the patient complained dysphagia, it was also necessary to study other possible mediastinal compressions by a contrast medium CT scan of the great vessels. The CT scanned brachiocephalic vein compression without additional clinical evidence or signs. Twenty hours after the trauma the patient underwent an unsuccessful closed reduction; for this reason, surgical treatment with open reduction and fixation was mandatory. After 12 weeks of therapy she returned to her previous sport activity. (www.actabiomedica)
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Affiliation(s)
- Filippo Calderazzi
- Dipartimento Scienze Chirurgiche Ospedale Maggiore Parma, U.O. Clinica Ortopedica.
| | - Margherita Menozzi
- a) Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, Via Gramsci 14,43100 Parma, Italy.
| | - Piergiulio Valenti
- a) Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, Via Gramsci 14,43100 Parma, Italy.
| | - Alessandra Colacicco
- a) Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, Via Gramsci 14,43100 Parma, Italy.
| | - Paolo Bastia
- a) Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, Via Gramsci 14,43100 Parma, Italy.
| | - Francesco Pogliacomi
- a) Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, Via Gramsci 14,43100 Parma, Italy.
| | - Francesco Ceccarelli
- a) Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, Via Gramsci 14,43100 Parma, Italy.
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Feng W, Cai X, Li S, Li Z, Zhang K, Wang H, Zhang J, Zhu Y, Feng D. Balser Plate Stabilization for Traumatic Sternoclavicular Instabilities or Medial Clavicle Fractures: A Case Series and Literature Review. Orthop Surg 2020; 12:1627-1634. [PMID: 32893491 PMCID: PMC7767773 DOI: 10.1111/os.12726] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE This study was performed to observe the effect of internal Balser plate fixation for treating unstable sternoclavicular joints (SCJ) and displaced medial clavicle fractures. METHODS From April 2009 to September 2016, 17 consecutive patients who underwent open reduction and internal Balser plate fixation for SCJ dislocations or medial clavicle fractures were retrospectively reviewed. There were 11 male and six female patients, with a mean age of 45.6 ± 15.5 years. Standardized treatment procedures consisted of reduction, creating a space posterior dorsal osteal face of the sternal manubrium, an inverted Balser plating, and postoperative immobilization. At follow-up, plain radiographs were assessed for fracture union, implant loosening, degenerative changes, and joint congruity. Clinical evaluation included: completion of the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire; determination of the Constant and Murley score and visual analog scale (VAS) score; and assessment of intraoperative and postoperative complications. RESULTS All patients were followed up, at a mean follow-up of 20.1 ± 7.9 months, each fracture had a solid union, and each dislocation showed no sign of recurrent dislocation. The mean shoulder forward flexion was 162.9° ± 8.1°. The mean DASH score was 5.2 ± 5.2 points. The mean Constant and Murley joint function score was 93.7 ± 7.9 points, with 15 excellent cases and two good cases. The mean VAS score was 1.1 ± 1.4 points, showing significant improvement compared with the VAS score preoperatively. Postoperative complications included one wound hematoma which was healed after a debridement and one recurrent instability due to hook migration, which underwent revision reconstruction. All patients were satisfied with their treatment outcome at the final follow-up. CONCLUSION Sternoclavicular joints dislocation or medial clavicle fractures can be treated successfully with Balser plate fixation. This technique permits early functional exercise while preserving the SCJ.
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Affiliation(s)
- Wei‐lou Feng
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Xiao Cai
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Shu‐hao Li
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Zi‐jun Li
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Kun Zhang
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Hao Wang
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Jun Zhang
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Yang‐jun Zhu
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Dong‐xu Feng
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
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Imam MA, Javed S, Trail I, Monga P. The unicortical sternoclavicular joint reconstruction using synthetic graft. Shoulder Elbow 2020; 12:144-147. [PMID: 32313564 PMCID: PMC7153205 DOI: 10.1177/1758573218790964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/29/2018] [Indexed: 11/16/2022]
Abstract
Sternoclavicular joint injuries represent 5% of all injuries to the shoulder complex. We report a safe and reproducible technique for reconstruction of anterior sternoclavicular joint dislocations, employing a synthetic graft using a unicortical technique with minimal dissection anterior to the joint.
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Affiliation(s)
- Mohamed A Imam
- Upper Limb Research Unit, The Upper Limb Unit, Wrightington Hospital, Wigan, UK,Trauma and Orthopaedics, Norfolk and Norwich University Hospitals NHS Foundation, Norwich, UK,Mohamed A Imam, Upper Limb Research Unit, The Upper Limb Unit, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan WN6 9EP, UK.
| | - Saqib Javed
- Upper Limb Research Unit, The Upper Limb Unit, Wrightington Hospital, Wigan, UK
| | - Ian Trail
- Upper Limb Research Unit, The Upper Limb Unit, Wrightington Hospital, Wigan, UK
| | - Puneet Monga
- Upper Limb Research Unit, The Upper Limb Unit, Wrightington Hospital, Wigan, UK
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Kendal JK, Thomas K, Lo IKY, Bois AJ. Clinical Outcomes and Complications Following Surgical Management of Traumatic Posterior Sternoclavicular Joint Dislocations: A Systematic Review. JBJS Rev 2019; 6:e2. [PMID: 30399119 DOI: 10.2106/jbjs.rvw.17.00157] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Traumatic posterior sternoclavicular joint dislocations are rare orthopaedic emergencies. Treatment typically consists of closed reduction, with surgical management reserved for unstable cases. Because of the low prevalence of this condition, limited clinical evidence exists for a superior surgical stabilization technique. METHODS A systematic review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. MEDLINE and Embase databases were searched using a comprehensive search strategy. A descriptive and critical analysis of the results was performed. RESULTS Forty relevant studies (108 cases) were identified. Favorable subjective and objective outcomes were reported for all 5 categories of stabilization described. The overall complication rate was 16%, including 4 cases of recurrent instability. Ligament reconstruction using tendon graft had the lowest recurrent instability and complication rates, and open reduction and internal fixation techniques required a second operation for implant removal in 80% of cases. CONCLUSIONS A comprehensive review of the surgical management of traumatic posterior sternoclavicular joint dislocations is presented. Results suggest favorable outcomes for all of the methods of stabilization, with a modest complication rate. The trends observed have helped to guide the development of clinical care recommendations that aid in treatment decision-making for these injuries. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Joseph K Kendal
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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Bakir MS, Unterkofler J, Hönning A, Haralambiev L, Kim S, Ekkernkamp A, Schulz-Drost S. Shoulder girdle injuries involving the medial clavicle differ from lateral clavicle injuries with a focus on concomitant injuries and management strategies: A retrospective study based on nationwide routine data. PLoS One 2019; 14:e0224370. [PMID: 31652299 PMCID: PMC6814233 DOI: 10.1371/journal.pone.0224370] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/13/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction Although shoulder girdle injuries are frequent, those of the medial part are widely unexplored. Our aim is to improve the knowledge of this rare injury and its management in Germany by big data analysis. Methods The data are based on ICD-10 codes of all German hospitals as provided by the German Federal Statistical Office. Based on the ICD-10 codes S42.01 (medial clavicle fracture, MCF) and S43.2 (sternoclavicular joint dislocation, SCJD), anonymized patient data from 2012 to 2014 were evaluated retrospectively for epidemiologic issues. We analyzed especially the concomitant injuries and therapy strategies. Results A total of 114,003 cases with a clavicle involving shoulder girdle injury were identified with 12.5% of medial clavicle injuries (MCI). These were accompanied by concomitant injuries, most of which were thoracic and craniocerebral injuries as well as injuries at the shoulder/upper arm. A significant difference between MCF and SCJD concerning concomitant injuries only appears for head injuries (p = 0.003). If MCI is the main diagnosis, soft tissue injuries typically occur as secondary diagnoses. The MCI are significantly more often associated with concomitant injuries (p < 0.001) for almost each anatomic region compared with lateral clavicle injuries (LCI). The main differences were found for thoracic and upper extremity injuries. Different treatment strategies were used, most frequently plate osteosynthesis in more than 50% of MCF cases. Surgery on SCJD was performed with K-wires, tension flange or absorbable materials, fewer by plate osteosynthesis. Conclusions We proved that MCI are rare injuries, which might be why they are treated by inhomogeneous treatment strategies. No standard procedure has yet been established. MCI can occur in cases of severely injured patients, often associated with severe thoracic or other concomitant injuries. Therefore, MCI appear to be more complex than LCI. Further studies are required regarding the development of standard treatment strategy and representative clinical studies.
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Affiliation(s)
- M. Sinan Bakir
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
- * E-mail:
| | - Jan Unterkofler
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
- Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Alexander Hönning
- Center of Clinical Science, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Lyubomir Haralambiev
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Simon Kim
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Axel Ekkernkamp
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Stefan Schulz-Drost
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Erlangen, Bayern, Germany
- Department of Trauma, Orthopedic and Hand Surgery, Helios Hospital Schwerin, Schwerin, Mecklenburg-Vorpommern, Germany
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Peebles LA, Aman ZS, Preuss FR, Samuelsen BT, Zajac TJ, Patel RB, Provencher MT. Chronic Instability and Pain of the Sternoclavicular Joint: Treatment With Semitendinosus Allograft to Restore Joint Stability. Arthrosc Tech 2019; 8:e629-e635. [PMID: 31334021 PMCID: PMC6624162 DOI: 10.1016/j.eats.2019.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/16/2019] [Indexed: 02/03/2023] Open
Abstract
Chronic instability of the sternoclavicular (SC) joint is a challenging clinical problem, particularly in a patient population for which nonoperative forms of treatment prove ineffective. Patients present after experiencing recurrent subluxation events and subsequent pain, which commonly result in increasing functional limitation. Recurrent SC joint instability of this nature can lead to damage of the SC joint cartilage and bone, and in cases of posterior subluxation or dislocation, damage to mediastinal structures. While the precise treatment algorithm requires tailoring to individual patients and their respective pathologies, we have demonstrated successful outcomes in correcting chronic SC joint instability by means of SC joint reconstruction with semitendinosus allograft, SC joint capsular reconstruction, and, in cases of arthritic damage, resection of a small portion of the degenerative component of the medial clavicle. The purpose of this Technical Note is to describe a technique that uses a semitendinosus allograft to stabilize the SC joint combined with a capsular reconstruction in patients who have previously failed nonoperative treatment methods.
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Affiliation(s)
- Liam A Peebles
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Zachary S Aman
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Fletcher R Preuss
- University of Virginia School of Medicine, Charlottesville, Virginia, U.S.A
| | | | | | - Ravi B Patel
- Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, Michigan, U.S.A
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,Steadman Clinic, Vail, Colorado, U.S.A
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Hirsiger S, Hasler A, Fürnstahl P, Gerber C. Chronic anterior sternoclavicular instability: technique and results of corrective clavicular osteotomy. J Shoulder Elbow Surg 2019; 28:724-730. [PMID: 30553799 DOI: 10.1016/j.jse.2018.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic anterior sternoclavicular (SC) instability is a rare but potentially disabling condition. It can arise in conjunction with trauma or hyperlaxity, or both. Numerous surgical techniques have been described, but no gold standard exists. SC instability is often position-dependent and can be reduced with the arm in a specific position. METHODS To directly address this issue, we used a technique of corrective osteotomy of the clavicle with the goal to reorient the articular portion of the medial end of the clavicle so that it remains stable in all functional positions of the arm. To illustrate the technique and the correction in space, we performed postoperative 3-dimensional computed tomography analyses of the shoulder girdle of 4 patients. Clinical scores were obtained at the final follow-up and compared with preoperative scores. RESULTS Mean follow-up was 64 months (range, 19-191 months). The mean Constant score improved from 58 (range, 45-68) preoperatively to 73 (range, 69-84) postoperatively and the Subjective Shoulder Value from 42 (range, 15-80) to 79 (range, 50-100). All patients reported good or very good stability of the SC joint at the last follow-up. We recorded no intraoperative or direct postoperative complications. During follow-up, 3 patients underwent removal of the plate, 1 of them for plate breakage. The mean postoperative correction for combined rotations is given as a 3-dimensional angle and averaged 28.0° (range, 8.6°-39.7°). CONCLUSION In this pilot study, medial corrective clavicular osteotomy using the described technique treated anterior SC instability with improvement of clinical shoulder function scores and good patient satisfaction. The technique appears simple and safe and deserves further evaluation.
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Affiliation(s)
- Stefanie Hirsiger
- Department of Orthopaedic Surgery, University Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Anita Hasler
- Department of Orthopaedic Surgery, University Hospital Balgrist, University of Zürich, Zürich, Switzerland.
| | - Philipp Fürnstahl
- Computer Assisted Research and Development Group, University Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Christian Gerber
- Department of Orthopaedic Surgery, University Hospital Balgrist, University of Zürich, Zürich, Switzerland
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18
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Qu YZ, Xia T, Liu GH, Zhou W, Mi BB, Liu J, Guo XD. Treatment of Anterior Sternoclavicular Joint Dislocation with Acromioclavicular Joint Hook Plate. Orthop Surg 2019; 11:91-96. [PMID: 30729708 PMCID: PMC6430452 DOI: 10.1111/os.12422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 11/11/2018] [Accepted: 12/13/2018] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of using acromioclavicular joint hook plates for the treatment of anterior sternoclavicular joint dislocation. METHODS Ten patients who suffered anterior sternoclavicular joint dislocation were retrospectively analyzed, and underwent acromioclavicular joint hook plate surgeries from January 2015 to May 2017. There were 7 male and 3 female patients, with a mean age of 43.6 years. According to the American Shoulder and Elbow Society (ASES) scoring system, the preoperative physical function had a mean of 83.5. RESULTS Reduction and fixation were performed with hook plates in all 10 patients. All patients were followed up, with a mean duration of 16.9 months. There were no complications, no wound infections, and no plate or screw breakages. Movement of the shoulder girdle was improved in all patients. According to the ASES scoring system, the postoperative physical function had a mean of 94.8. CONCLUSION The acromioclavicular joint hook plate demonstrates safety and efficacy for the treatment of anterior sternoclavicular joint dislocation. However, there are still some deficiencies that need to be improved.
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Affiliation(s)
- Yan-Zhen Qu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tian Xia
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guo-Hui Liu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wu Zhou
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo-Bin Mi
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Liu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Dong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Gerich T, Hoffmann A, Backes F, Duinslaeger AD, Seil R, Pape D. Anterior buttress plate is successful for treating posterior sterno-clavicular dislocation. Knee Surg Sports Traumatol Arthrosc 2019; 27:251-258. [PMID: 30478469 DOI: 10.1007/s00167-018-5298-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/13/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Traumatic posterior instability of the sternoclavicular joint is a potentially life-threatening injury. In contrast to the low incidence there is a plethora of different strategies to treat this lesion. It was the objective of this retrospective analysis to evaluate and further develop current strategies. METHODS In this retrospective analysis all posterior dislocations that were diagnosed and treated between 2011 and 2018 were included. In this 7 year period, eight male patients (median age 32 years) were operated. RESULTS Three patients were not diagnosed at the primary institution and were referred later. Five patients were treated with an anterior buttress plate with clavicular stabilisation only. One patient was stabilized with a temporary sternoclavicular arthrodesis. Two patients were operated using an autologous tendon graft. All of the patients underwent an immediate postoperative CT-scan that documented the anatomical articulation. All patients treated with a plate underwent implant removal. A final CT examination after removal documented the maintenance of the anatomic alignment. CONCLUSIONS The buttress plate technique with clavicular screw fixation is a sufficient treatment to restore and preserve a normal sternoclavicular alignment. The technique finds its indication in unidirectional posterior instability. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Torsten Gerich
- Centre Hospitalier de Luxembourg, 4, Rue Barble, 1210, Luxembourg, Luxembourg.
| | - Alexander Hoffmann
- Centre Hospitalier de Luxembourg, 76 Rue d'Eich, 1460, Luxembourg, Luxembourg
| | - Francois Backes
- Centre Hospitalier de Luxembourg, 4, Rue Barble, 1210, Luxembourg, Luxembourg
| | | | - Romain Seil
- Centre Hospitalier de Luxembourg, 76 Rue d'Eich, 1460, Luxembourg, Luxembourg
| | - Dietrich Pape
- Centre Hospitalier de Luxembourg, 76 Rue d'Eich, 1460, Luxembourg, Luxembourg
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20
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Sun Y, Yang Y, Ge J, Yang K, Xiang F, Zhou J, Liang J. [Development and clinical application of a new type of anatomical locking plate for sternoclavicular joint fracture and dislocation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:316-321. [PMID: 29806281 PMCID: PMC8414276 DOI: 10.7507/1002-1892.201707081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 02/03/2018] [Indexed: 11/03/2022]
Abstract
Objective To report a new type of anatomical locking plate for sternocalvicular joint, and investigate its effectiveness in treatment of sternoclavicular joint fracture and dislocation. Methods A new type of anatomical locking plate for sternoclavicular joint was developed, which accorded with the anatomical features and biomechanical characteristics of Chinese sternoclavicular joint. By adopting the method of clinical randomized controlled study, 32 patients with the sternoclavicular joint fracture and dislocation who met the selection criteria between June 2008 and May 2015 were randomly divided into groups A and B ( n=16), and the patients were treated with new anatomic locking plate and distal radial T locking plate internal fixation, respectively. There was no significant difference between 2 groups in gender, age, injured side, body mass index, cause of injury, type of injury, the time from injury to operation, and preoperative Rockwood grading score ( P>0.05). The operation time, intraoperative blood loss, incision length, hospitalization time, and postoperative complications in 2 groups were recorded, and the effectiveness was evaluated by Rockwood grading score. Results The operations of 2 groups completed successfully. The operation time, intraoperative blood loss, and hospitalization time in group A were significantly less than those in group B ( P<0.05), but there was no significant difference in the incision length between 2 groups ( t=0.672, P=0.507). All the patients were followed up 18-30 months (mean, 24 months). In group A, there were 1 case of sternoclavicular joint pain and 2 cases of wound infection; in group B, there were 1 case of sternoclavicular joint pain, 1 case of internal fixation loosening, and 1 case of sternoclavicular joint re-dislocation; there was no significant difference in complication incidence between 2 groups ( P=1.000). The Rockwood grading scores at each time point after operation in 2 groups were significantly higher than those before operation. At 1 month after operation, the Rockwood grading score in group A was significantly higher than that in group B ( t=2.270, P=0.031); but there was no significant difference in the Rockwood grading scores between the 2 groups at 6 months and at last follow-up ( P>0.05). At last follow-up, according to the Rockwood scoring standard, the results of group A were excellent in 13 cases, good in 2 cases, poor in 1 case, the excellent and good rate was 93.75%; the results of group B were excellent in 11 cases, good in 4 cases, poor in 1 case, and the excellent and good rate was 93.75%; there was no significant difference between 2 groups ( Z=-0.748, P=0.455). Conclusion The new type of anatomic locking plate accords with the Chinese anatomical characteristics. It has the advantages of easy operative procedure, less surgical trauma, shorter operation time, less intraoperative blood loss, shorter hospitalization time, and it can achieve better results in the treatment of sternoclavicular joint fracture and dislocation.
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Affiliation(s)
- Yuanlin Sun
- Department of Bone and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Yunkang Yang
- Department of Bone and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000,
| | - Jianhua Ge
- Department of Bone and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Kun Yang
- Department of Bone and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Feifan Xiang
- Department of Bone and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Ju Zhou
- Department of Bone and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Jie Liang
- Department of Bone and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
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Gun B, Dean R, Go B, Richardson C, Waterman BR. Non-modifiable Risk Factors Associated with Sternoclavicular Joint Dislocations in the U.S. Military. Mil Med 2018; 183:e188-e193. [DOI: 10.1093/milmed/usx095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Indexed: 11/12/2022] Open
Abstract
Abstract
INTRODUCTION
Sternoclavicular joint (SCJ) dislocations, although uncommon, are observed in patients with ligamentous laxity as well as those who experience traumatic injuries. The incidence and epidemiology of this costly and debilitating injury to our relatively young and active military population have not previously been reported. The purpose of this study is to consider and quantify the non-modifiable risk factors associated with this injury.
METHODS
Using Defense Medical Epidemiological Database, first-time occurrences, from 2006 to 2015 for the ICD-9-CM code 839.61 (closed dislocation of the SCJ), were obtained and further categorized by gender, race, age, rank, and branch of service. Race was classified based on self-reporting of patients into White, Black, or other categories. Age was divided into the categories of less than 20 yr, 20–24 yr, 25–29 yr, 30–34 yr, 35–39 yr, and greater than 40 yr. Rank was categorized as junior enlisted (E-1 to E-4), senior enlisted (E-5 to E-9), junior officer (O-1 to O-3), and senior officer (O-4 to O-10). Branch of service includes Army, Navy, Air Force, and Marines. Multivariate data analysis was performed to obtain rate per 1,000 person-years as well as adjusted rate (adjusted for age group, gender, race, rank, and service) to isolate risk factors.
RESULTS
Between 2006 and 2015, 427 cases of closed SCJ dislocations occurred among an at-risk population of 13,772,342 person-years for an unadjusted incidence rate (IR) of 0.031 per 1,000 person-years. The annual unadjusted IR ranged from 0.017 in 2006 to 0.059 in 2014 with the greatest increase occurring between 2006 and 2007 representing 61% increase in the rate of injuries. Males were almost twice as likely to sustain these injuries compared with females (adjusted rate ratio 1.73; 95% confidence interval [CI] 1.23, 2.43). Age was not found to be a risk factor for the development of these injuries with IRs for each age group overlapping with 95% CI for all other age groups. Similarly, the other category for race was also not found to be a statistically significant risk factor. Junior Officers (adjusted rate 0.017; 95% CI 0.011, 0.025) were found least likely to suffer from these injuries with Junior Enlisted (0.034; 95% CI 0.030, 0.040) and Senior Enlisted (0.032; 95% CI 0.028, 0.037) most at risk. Being in the Navy (0.019; 95% CI 0.015, 0.025) was found to be most protective compared with Air Force (0.032; 95% CI 0.026, 0.039), Army (0.036; 95% CI 0.031, 0.041), and Marines (0.036; 95% CI 0.028, 0.045).
DISCUSSION and CONCLUSION
Annual unadjusted IR of SCJ dislocations readily increased from 2006 to 2014. Statistically significant risk factors, for suffering a closed SCJ dislocation, identified by our study, were male sex, enlisted rank, and branch of service other than Navy. Age and race were not found to have a statistically significant risk. These results can shed light on non-modifiable risk factors for dislocations of the SCJ and can be used in other studies to aid in reducing injury burden on the U.S. Military.
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Affiliation(s)
- Baris Gun
- Department of Graduate Medical Education, William Beaumont Army Medical Center, 5005 N Piedras Street, El Paso, TX 79930
| | - Robert Dean
- Midwest Orthopaedics at RUSH, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612
| | - Beatrice Go
- Midwest Orthopaedics at RUSH, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612
| | - Catherine Richardson
- Midwest Orthopaedics at RUSH, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612
| | - Brian R Waterman
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, 4th Floor Watlington Hall, Medical Center Boulevard, Winston-Salem, NC 27157
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Yang K, Yang Y, Ge J, Li G, Wu T, Bai R, Xiang F, Sun Y. [Development and biomechanical study of anatomical locking plate of sternoclavicular joint]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:7-13. [PMID: 29806357 PMCID: PMC8414206 DOI: 10.7507/1002-1892.201705094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 12/22/2017] [Indexed: 11/03/2022]
Abstract
Objective To develop an anatomical locking plate in accordance with the anatomical characteristics of the sternoclavicular joint, which is reliable fixation and easy to operate, so as to provide an ideal internal fixation device for the treatment of sternoclavicular joint dislocation or peripheral fractures. Methods Gross measurement and CT measurement were performed on the 8 adult antiseptic and moist cadaver specimens (16 sides) to measure the parameters of surrounding bone structure of the sternoclavicular joint. The parameters included the thickness of presternum, sternal notch width, anteroposterior diameter of proximal 1/3 of clavicle, upper and lower diameters of proximal 1/3 of clavicle, angle between proximal end of clavicle and presternum in coronal plane, and angle of thoracoclavicular joint at anatomic position forward. According to the anatomical parameters and biomechanical properties of the specimens, the anatomical locking plate was designed and developed. The sternoclavicular ligament and joint capsule of all the specimens were completely cut off to make the sternoclavicular joint dislocation model. The left and right sternoclavicular joint of each specimen were randomly divided into experimental group (anatomic locking plate fixation) and control group (oblique T shape locking plate fixation). The sternoclavicular joint activity and common force mechanism was simulated on the universal mechanical testing machine, and the clavicular distal load test, sternoclavicular joint torsion test, and anti-pulling of steel plate manubrium part test were performed. Results The differences between the anatomical parameters of gross measurement and CT measurement were not significant ( P>0.05). In the clavicular distal load test, when the anatomical position perpendicular to the distal clavicle back loading to 20 N, the displacement of loading point in the experimental group was (8.455±0.981) mm, which was significantly less than that in control group [(10.163±1.379) mm] ( t=-3.012, P=0.020); the distal clavicle displacement of loading point of experimental group and control group were (5.427±1.154) mm and (6.393±1.040) mm, respectively, showing no significant difference ( t=-1.459, P=0.188)。In the sternoclavicular joint torsion test, the torque of experimental group was significantly greater than that of control group when the clockwise torsion angle was at 2, 4, 6, 8, and 10 degrees and the counterclockwise torsion angle was at 4, 6, 8, and 10 degrees ( P<0.05). The torsional stiffness in the experimental group under clockwise and counterclockwise condition was 0.122 and 0.108 N·m/° respectively, which were significantly higher than those in the control group (0.083 and 0.078 N·m/° respectively) ( F=67.824, P=0.000; F=20.992, P=0.002). In the anti-pulling of steel plate manubrium part test, the maximum pullout force of experimental group [(225.24±16.02) N] was significantly higher than that in control group [(174.40±21.90) N] ( t=5.785, P=0.001). Conclusion The new type of anatomical locking plate can realize the sternoclavicular joint three-dimensional fixation, and has the advantages of reliable fixation, simple operation, less trauma, superior biomechanical properties, and earlier functional exercise. It may be an ideal internal fixation device in clinical treatment of sternoclavicular joint dislocation or peripheral fractures.
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Affiliation(s)
- Kun Yang
- Department of Orthopedics, Luzhou People's Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Yunkang Yang
- Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000,
| | - Jianhua Ge
- Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Gen Li
- Department of Orthopedics, Luzhou People's Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Tianhao Wu
- Department of Orthopedics, Luzhou People's Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Rui Bai
- Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Feifan Xiang
- Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Yuanlin Sun
- Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
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Bipolar Dislocation of the Clavicle: A Report of Two Cases with Different Injury Patterns and a Literature Review. Case Rep Orthop 2017. [PMID: 29527368 PMCID: PMC5763060 DOI: 10.1155/2017/2935308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bipolar dislocation of the clavicle is a rare injury that is defined as a concomitant dislocation of the ipsilateral acromioclavicular joint and sternoclavicular joint. This injury is also described as a floating clavicle. Although this injury has been known for nearly two centuries, knowledge about it is limited and the treatment strategy remains controversial. Bipolar dislocation includes several combinations of both joints' injury types. We reported two patients with bipolar dislocation of the clavicle: one with an anterior dislocation and the other with a posterior dislocation of the sternoclavicular joint. After reviewing the currently available literature, we discussed these cases to highlight the necessity of a specific treatment approach that is modified based on the pattern of each joint's lesion.
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