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Walia P, Fredette R, Mortimer E. Missed Medial Clavicular Physeal Fracture-Posterior Dislocation Complicated by Brachiocephalic Pseudoaneurysm: A Case Report. JBJS Case Connect 2024; 14:01709767-202409000-00036. [PMID: 39172876 DOI: 10.2106/jbjs.cc.24.00180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
CASE We present a 17-year-old male patient with an initially missed posterior sternoclavicular fracture dislocation who presented with symptoms related to thrombotic emboli arising from a pseudoaneurysm. He was treated 6 weeks after injury with a figure-of-eight tendon allograft repair with good clinical outcomes. CONCLUSION This is a unique presentation that highlights the significant risk of a missed diagnosis, life-threatening complications that may ensue, and biomechanically superior surgical intervention.
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Affiliation(s)
- Palak Walia
- Department of Orthopedics, University of Massachusetts Chan Medical Center, Worcester, Massachusetts
- University of Massachusetts Chan Medical Center, Worcester, Massachusetts
| | - Ryan Fredette
- University of Massachusetts Chan Medical Center, Worcester, Massachusetts
| | - Errol Mortimer
- Department of Orthopedics, University of Massachusetts Chan Medical Center, Worcester, Massachusetts
- University of Massachusetts Chan Medical Center, Worcester, Massachusetts
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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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Burns S, Thangarajah T, Lambert S. Two cases of sternoclavicular joint replacement arthroplasty: A case report. A novel prosthesis and surgical technique for recalcitrant instability, arthropathy of the sternoclavicular joint with medial clavicular bone loss. SAGE Open Med Case Rep 2023; 11:2050313X231153032. [PMID: 36798681 PMCID: PMC9926365 DOI: 10.1177/2050313x231153032] [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: 03/07/2022] [Accepted: 01/09/2023] [Indexed: 02/15/2023] Open
Abstract
Instability arthropathy of the sternoclavicular joint is most commonly managed by rehabilitation, injection, and either arthroscopic or open debridement with or without interposition arthroplasty. When these options fail to achieve symptom relief, excision arthroplasty is an option. This is associated with a risk of persistent instability and incomplete pain relief. We describe two cases in which custom sternoclavicular joint replacement was performed for painful insufficiency of scapular suspension. Although the prostheses remained secure in both cases, the first case was complicated by persistent instability due to insufficient reconstruction of the intrinsic sternoclavicular capsular ligaments. This was recognised and corrected for in the second case, in which stability of the sternoclavicular joint replacement has been noted on more than a 5-year review. We conclude that sternoclavicular joint replacement is an option for patients in whom instability arthropathy remains an intrusive problem in daily life after other conventional treatments have not controlled symptoms. Stability of the joint remains a concern. We offer one method of achieving stability through an iterative design process including the ability to reconstruct the intrinsic capsular ligaments around the articulation.
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Affiliation(s)
- Sophia Burns
- Trauma and Orthopaedic Department, University College London Hospitals, London, UK,Sophia Burns, Trauma and Orthopaedic Department, University College London Hospitals, 250 Euston Road, London NW1 2PG, UK.
| | - Tanujan Thangarajah
- Department of Shoulder & Elbow Surgery, University of Calgary, Calgary, AB, Canada
| | - Simon Lambert
- Trauma and Orthopaedic Department, University College London Hospitals, London, UK
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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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Athanatos L, Kulkarni K, Tunnicliffe H, Samaras M, Singh HP, Armstrong AL. Midterm results of chronic anterior instability of the sternoclavicular joint managed using a standardized treatment algorithm. Bone Jt Open 2022; 3:815-825. [PMID: 36263725 PMCID: PMC9626857 DOI: 10.1302/2633-1462.310.bjo-2022-0088] [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: 11/06/2022] Open
Abstract
AIMS There remains a lack of consensus regarding the management of chronic anterior sternoclavicular joint (SCJ) instability. This study aimed to assess whether a standardized treatment algorithm (incorporating physiotherapy and surgery and based on the presence of trauma) could successfully guide management and reduce the number needing surgery. METHODS Patients with chronic anterior SCJ instability managed between April 2007 and April 2019 with a standardized treatment algorithm were divided into non-traumatic (offered physiotherapy) and traumatic (offered surgery) groups and evaluated at discharge. Subsequently, midterm outcomes were assessed via a postal questionnaire with a subjective SCJ stability score, Oxford Shoulder Instability Score (OSIS, adapted for the SCJ), and pain visual analogue scale (VAS), with analysis on an intention-to-treat basis. RESULTS A total of 47 patients (50 SCJs, three bilateral) responded for 75% return rate. Of these, 31 SCJs were treated with physiotherapy and 19 with surgery. Overall, 96% (48/50) achieved a stable SCJ, with 60% (30/50) achieving unrestricted function. In terms of outcomes, 82% (41/50) recorded good-to-excellent OSIS scores (84% (26/31) physiotherapy, 79% (15/19) surgery), and 76% (38/50) reported low pain VAS scores at final follow-up. Complications of the total surgical cohort included a 19% (5/27) revision rate, 11% (3/27) frozen shoulder, and 4% (1/27) scar sensitivity. CONCLUSION This is the largest midterm series reporting chronic anterior SCJ instability outcomes when managed according to a standardized treatment algorithm that emphasizes the importance of appropriate patient selection for either physiotherapy or surgery, based on a history of trauma. All but two patients achieved a stable SCJ, with stability maintained at a median of 70 months (11 to 116) for the physiotherapy group and 87 months (6 to 144) for the surgery group.Cite this article: Bone Jt Open 2022;3(10):815-825.
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Affiliation(s)
- Lambros Athanatos
- Leicester Shoulder Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | | | - Harvinder P. Singh
- Leicester Shoulder Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Alison L. Armstrong
- Leicester Shoulder Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
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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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Karan CL, Ravish VN, Channappa TS, Raju GB, Jayaram M. Traumatic sternoclavicular joint dislocation - A case series and discussion of methods of management. JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2022. [DOI: 10.4103/jodp.jodp_35_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Repair of sternoclavicular joint ligament: a novel approach. Ir J Med Sci 2021; 191:2141-2145. [PMID: 34719778 DOI: 10.1007/s11845-021-02826-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Posterior sternoclavicular dislocations are common in younger patients and are frequently due to high energy sporting incidents. AIM We aim to demonstrate a novel technique that is safe and aims to provide good functional post-operative outcomes for patients with this injury. METHODS This was a single-surgeon case series of four young patients from October 2017 to July 2019. The operative technique involved relocating the joint and holding it in situ with nylon suture tape. The tape was anchored in holes drilled in the sternum and passed through tunnels drilled into the medial clavicle. All of the patients were contacted retrospectively and a Nottingham Clavicle Score (NCS) was performed for each patient on a post-operative basis. RESULTS No intra-operative or post-operative complications were noted. All of the patients demonstrated a significant improvement in their functional outcomes after the operation. The average NCS for the four patients was 82/100. DISCUSSION There are a variety of techniques described in the literature to repair this ligament using either plates or tendon grafts. All of these techniques describe the drilling of anteroposterior holes in the manubrium and clavicle which run the intra-operative risk of perforating a major vessel. This paper is the first one to describe a technique which uses superior inferior holes which minimizes the risks, making the procedure safer for the patient. CONCLUSIONS We believe this novel technique is safer than the existing described techniques, and it does not compromise on functional outcomes.
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Reuter P, Chen K, Klestil T, Stotter C. Surgical treatment of anterior sternoclavicular dislocation associated with midshaft clavicle fracture: A case report. Jt Dis Relat Surg 2021; 32:560-565. [PMID: 34145841 PMCID: PMC8343839 DOI: 10.52312/jdrs.2021.135] [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: 03/31/2021] [Accepted: 05/07/2021] [Indexed: 12/02/2022] Open
Abstract
A combination of an anterior sternoclavicular (SC) joint dislocation with a midshaft clavicle fracture is an extremely rare injury. If left untreated, it can lead to severely impaired function of the shoulder with a high risk for complications. A 45-year-old male patient presented with pain and impaired range of motion (ROM) in the left shoulder after a mountain bike crash. Radiographs and a computed tomography scan showed an anterior dislocation of the left SC joint and an ipsilateral midshaft fracture of the clavicle. Open reduction and internal fixation (ORIF) of the clavicle combined with SC joint stabilization using transosseous sutures was performed. Postoperatively, a shoulder-arm bandage was applied with passive motion starting on the first postoperative day. During follow-up, the patient showed an improved clinical function and could return to work after three weeks. Radiographs at eight weeks showed fracture healing without any signs of recurrent SC dislocation. At the final follow-up at 12 weeks, the patient returned to his pre-injury activity level and recreational sports. Despite minimal redislocation in the SC joint, the Constant-Murley Score showed a continuous improvement with 93%, compared to the contralateral side. In conclusion, surgical treatment of anterior SC joint dislocation with a midshaft clavicle fracture can restore shoulder function with no surgery-associated complications.
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Affiliation(s)
- Philippe Reuter
- Department of Orthopaedics and Traumatology, Landesklinikum Baden-Mödling, 2340 Mödling, Austria.
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12
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Ben-Ari E, Magone KM, Lowe DT, Costas B, Rokito AS, Virk MS. Locked Anterior-Inferior Sternoclavicular Joint Dislocation: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00048. [PMID: 33886520 DOI: 10.2106/jbjs.cc.20.00780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a rare variant of sternoclavicular joint (SCJ) dislocation, namely locked anterior-inferior dislocation, with unique clinical, radiographic, and intraoperative findings. In this variant, the medial clavicle was displaced anteriorly and inferiorly and locked in the manubrial-intercostal space, with corresponding mechanical dysfunction of the ipsilateral shoulder girdle joints. Symptoms unique to this variant included painful neck spasms and limited glenohumeral elevation. Nonsurgical treatment was not successful, and open reduction and ligament reconstruction resulted in correction of the fixed deformity with resolution of the clinical symptoms. CONCLUSION Locked anterior-inferior SCJ dislocation is indicated for early open reduction and ligament reconstruction.
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Affiliation(s)
- Erel Ben-Ari
- Department of Orthopaedic Surgery, Division of Shoulder and Elbow, New York University Langone Health, Grossman School of Medicine, New York, New York.,Division of Orthopaedic Surgery, Tel-Hashomer "Sheba" Medical Center, Ramat Gan, Israel
| | - Kevin M Magone
- Department of Orthopaedic Surgery, Division of Shoulder and Elbow, New York University Langone Health, Grossman School of Medicine, New York, New York
| | - Dylan T Lowe
- Department of Orthopaedic Surgery, Division of Shoulder and Elbow, New York University Langone Health, Grossman School of Medicine, New York, New York
| | - Bizekis Costas
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Andrew S Rokito
- Department of Orthopaedic Surgery, Division of Shoulder and Elbow, New York University Langone Health, Grossman School of Medicine, New York, New York
| | - Mandeep S Virk
- Department of Orthopaedic Surgery, Division of Shoulder and Elbow, New York University Langone Health, Grossman School of Medicine, New York, New York
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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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Garcia JA, Arguello AM, Momaya AM, Ponce BA. Sternoclavicular Joint Instability: Symptoms, Diagnosis And Management. Orthop Res Rev 2020; 12:75-87. [PMID: 32801951 PMCID: PMC7395708 DOI: 10.2147/orr.s170964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/13/2020] [Indexed: 12/24/2022] Open
Abstract
Sternoclavicular joint (SCJ) instability is a rare condition and results from either a traumatic high energy impact, such as a motor vehicle crash or contact sports injury, or non-traumatically as a result of structural pathology. The infrequency of this injury has contributed to its diagnosis being missed as well as the paucity of literature on treatment and outcomes. Patients with SCJ instability often report diminished range of motion as well as shoulder girdle pain. The presentation of instability in the sternoclavicular joint can vary in severity and anterior or posterior directionality. Variation in severity of the instability changes the course of treatment regarding either operative or non-operative interventions to stabilize the SCJ. In general, anterior instability of the SCJ (the medial clavicle is displaced anterior to the sternum) is less urgent and generally manageable by symptom alleviation and rehabilitation, although some anterior instability cases require surgical intervention. In the case of posterior SCJ instability (the medial clavicle is displaced posterior to the sternum), patients require prompt joint reduction as they are at the greater risk of life-threatening injury due to the location of critical structures of the mediastinum posterior to the SCJ. Computed tomography visualization is useful to confirm dislocation or subluxation direction to better formulate a proper treatment plan. The purpose of this review is to report the clinical presentation and management of SCJ instability including pertinent symptoms, the diagnostic approaches to evaluating SCJ instability, as well as operative and non-operative management of the joint instability.
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Affiliation(s)
- Jacob A Garcia
- University Of Alabama At Birmingham School Of Medicine, Birmingham, AL 35294, USA
| | - Alexandra M Arguello
- University Of Alabama At Birmingham, Department Of Orthopedic Surgery, Birmingham, AL 35294, USA
| | - Amit M Momaya
- University Of Alabama At Birmingham, Department Of Orthopedic Surgery, Birmingham, AL 35294, USA
| | - Brent A Ponce
- University Of Alabama At Birmingham, Department Of Orthopedic Surgery, Birmingham, AL 35294, USA
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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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16
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Hautala GS, Kamineni S. Recurrent anterior sternoclavicular joint subluxation: long-term implant-related recurrence. JSES Int 2019; 4:55-58. [PMID: 32515407 PMCID: PMC7075775 DOI: 10.1016/j.jses.2019.10.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Affiliation(s)
- Gavin S Hautala
- Department of Orthopaedic Surgery and Sports Medicine, Elbow Shoulder Research Center, University of Kentucky, Lexington, KY, USA
| | - Srinath Kamineni
- Department of Orthopaedic Surgery and Sports Medicine, Elbow Shoulder Research Center, University of Kentucky, Lexington, KY, USA
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17
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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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18
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Robertson FML, Mohammed AA, Frostick SP. Sternoclavicular joint replacement case report. J Orthop Surg (Hong Kong) 2019. [PMID: 29529953 DOI: 10.1177/2309499018761176] [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: 11/16/2022] Open
Abstract
INTRODUCTION This report describes the first known sternoclavicular joint (SCJ) replacement with a custom-made prosthesis. HISTORY A 42-year-old male who presented post left medial clavicular excision with significant pain and limited range of motion impeding his daily activities and ability to work. The patient subsequently underwent a left SCJ arthroplasty with a custom-made prosthesis. Postoperatively, the patient suffered an anterior dislocation of the prosthetic joint which was successfully rectified and stabilized with soft tissue reconstruction, creating a pseudo-capsule from adjacent tissues of the joint. Thereafter, the patient required a final procedure to remove prominent sutures. RESULTS Currently, the patient has regained full range of motion and is pain free during most activities and has now returned to work, with a plan to review his progress in 1 year. These initial promising results post SCJ replacement with the custom-made prosthesis could potentially lead SCJ reconstruction in an exciting new direction. DISCUSSION More research should be encouraged regarding this nascent operative option, in order to identify the indications, parameters, and effectiveness of SCJ arthroplasty.
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19
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Wang H, Wang C, Ruan J, Wu W. Asymmetrical bilateral sternoclavicular joint dislocation combined with bilateral clavicular fracture: A case report. Medicine (Baltimore) 2019; 98:e16359. [PMID: 31305431 PMCID: PMC6641823 DOI: 10.1097/md.0000000000016359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Asymmetrical bilateral sternoclavicular joint (SCJ) dislocation consists of posterior SCJ dislocation on one side and anterior SCJ dislocation on the other side. This is an extremely rare injury and only a few cases have been reported in the literature. If not been diagnosed timely and accurately, asymmetrical bilateral SCJ dislocation can be life-threatening. PATIENTS CONCERNS We experienced a patient who has a life-threatening posterior dislocation of right SCJ and anterior dislocation on the left SCJ combined with bilateral clavicular fracture after a traffic accident. DIAGNOSES A computed tomography (CT) scan with three-dimensional reconstructions of SCJ showed potentially life-threatening posterior dislocation of right SCJ and anterior dislocation on the left SCJ combined with bilateral clavicular fracture. INTERVENTIONS Because of failed attempts at closed reduction, electively surgical intervention was made. We repaired the ruptured joint capsule and ligaments and fixed bilateral SCJ by Kirschner wire during the operation. OUTCOMES Three-dimensional CT scans confirmed bilateral SCJ reduction and alignment after operation 1 week as well as at the 2-month follow-up. LESSONS SCJ dislocation is an extremely rare and life-threatening injury. The aim of the operation is to repair the ruptured joint capsule and its ligaments and to fix the dislocated joints.
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Affiliation(s)
| | - Chongyang Wang
- Department of Respiration, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
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20
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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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21
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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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22
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Ipsilateral sternoclavicular joint anterior dislocation with fracture of the mid shaft of the clavicle. J Clin Orthop Trauma 2019; 10:510-513. [PMID: 31061579 PMCID: PMC6492214 DOI: 10.1016/j.jcot.2018.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/02/2018] [Indexed: 11/21/2022] Open
Abstract
Even though fractures of the clavicle are very common but fracture of the shaft of clavicle associated with sternoclavicular joint dislocation is extremely rare. This is a case report of a 50-year old woman who met with a road accident. Radiographs revealed right mid shaft clavicle fracture with inferior angulation of fracture fragments, anterior dislocation of sternoclavicular joint. The sternoclavicular joint was stabilized with sutures whereas the midshaft fracture was managed non-operatively. In postoperative period the sternoclavicular joint was found stable whereas the shaft clavicle united completely after 6 months.
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23
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Dhawan R, Singh RA, Tins B, Hay SM. Sternoclavicular joint. Shoulder Elbow 2018; 10:296-305. [PMID: 30214497 PMCID: PMC6134528 DOI: 10.1177/1758573218756880] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/14/2017] [Accepted: 12/31/2017] [Indexed: 12/16/2022]
Abstract
The sternoclavicular joint is a saddle shaped, synovial joint and is the only skeletal articulation between the axial skeleton and the upper limb. Here, a reviewis provided of the anatomy, biomechanics, traumatic and atraumatic conditions, and management options for the various conditions described.
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Affiliation(s)
- Rohit Dhawan
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, UK,Rohit Dhawan, Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, SY10 7AG, UK.
| | - Rohit Amol Singh
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, UK
| | - Bernhard Tins
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, UK
| | - Stuart M. Hay
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, UK,Royal Shrewsbury Hospital, Shrewsbury, Shropshire, UK
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24
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Ishii N, Matsumura N, Iwamoto T, Sato K, Nakamura M, Matsumoto M. Temporary Sternoclavicular Stabilization Using an Innovative Blocking Technique with Kirschner Wires for the Treatment of Posterior Sternoclavicular Joint Injury in Adolescent Patients: A Report of Two Cases. JBJS Case Connect 2018; 8:e76. [PMID: 30256246 DOI: 10.2106/jbjs.cc.18.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 15-year-old boy with a posterior physeal fracture-dislocation of the medial aspect of the clavicle and a 14-year-old boy with a posterior sternoclavicular joint dislocation were successfully treated with temporary sternoclavicular stabilization using an innovative blocking technique with Kirschner wires. CONCLUSION When treating posterior sternoclavicular joint injuries, posterior instability should be securely stabilized. Temporary blocking stabilization of the sternoclavicular joint using Kirschner wires does not rigidly fix the sternoclavicular joint, but it prevents posterior displacement of the proximal aspect of the clavicle. This stabilizing technique is a simple, safe, and viable treatment option for adolescent patients with a posterior sternoclavicular joint injury.
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Affiliation(s)
- Nariyoshi Ishii
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazuki Sato
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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25
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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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26
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Tytherleigh-Strong G, Pecheva M, Titchener A. Treatment of First-Time Traumatic Anterior Dislocation of the Sternoclavicular Joint With Surgical Repair of the Anterior Capsule Augmented With Internal Bracing. Orthop J Sports Med 2018; 6:2325967118783717. [PMID: 30046630 PMCID: PMC6055321 DOI: 10.1177/2325967118783717] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Traumatic anterior dislocations of the sternoclavicular joint (SCJ) are rare. Although they can usually be treated by a closed reduction, the reported subsequent recurrence rate is 50%. Purpose To determine whether further instability after first-time traumatic anterior dislocation would be prevented by a minimally invasive open repair of the anterior SCJ capsule, augmented with internal bracing. Study Design Case series; Level of evidence, 4. Methods Open repair of the anterior SCJ capsule was completed on a series of patients who had sustained a first-time traumatic anterior dislocation of the SCJ. Patients with preexisting SCJ instability and recurrent dislocations were excluded. Through a transverse incision, the anterior SCJ capsule was repaired and plicated by use of sutures. The repair was then protected by use of an internal brace, bridging between the sternum and the medial end of the clavicle. Results Six patients (4 males, 2 females) with a mean age of 28.3 years were included. Four patients underwent surgery within 4 weeks of their dislocation, and 2 patients had ongoing symptoms of instability but had not had a further dislocation. The median follow-up was 28.2 months (range, 24-35 months). At the most recent follow-up, none of the patients had sustained further dislocation or episode of instability, and their SCJs appeared stable. The mean abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was 2.3 (range, 0-4.5). Conclusion The medium-term results of this case series suggest that after first-time dislocation, surgical repair of the anterior SCJ capsule augmented with internal bracing can prevent recurrent instability. This may be an attractive option for individuals involved in higher risk activities, as the operative management of recurrent anterior SCJ instability usually requires a figure-of-8 tendon reconstruction, which carries a significantly higher morbidity.
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Affiliation(s)
- Graham Tytherleigh-Strong
- Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals Trust, Cambridge, UK
| | - Mira Pecheva
- Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals Trust, Cambridge, UK
| | - Andrew Titchener
- Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals Trust, Cambridge, UK
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27
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Sternoclavicular Joint Reconstruction in the Setting of Medial Comminuted Clavicle Fracture. Arthrosc Tech 2017; 6:e1355-e1359. [PMID: 29354440 PMCID: PMC5622535 DOI: 10.1016/j.eats.2017.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/21/2017] [Indexed: 02/03/2023] Open
Abstract
A dislocation of the sternoclavicular joint is a particularly threatening injury given the close proximity of neighboring vital structures. Moreover, a traumatic injury resulting in a comminuted fracture of the medial clavicle in addition to joint instability results in even greater complexity. In the setting of sternoclavicular joint instability, definitive treatment that will lead to complete resolution of symptoms is necessary. Various treatment methods, both conservative and operative, with positive treatment outcomes have been described. The aim of this Technical Note is to describe our preferred surgical technique to treat a medial comminuted clavicle fracture with anterior sternoclavicular joint instability.
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28
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Abstract
PURPOSE Up to 50% of traumatic sternoclavicular joint (SCJ) dislocations need open reduction and fixation to prevent long-term complications and complaints. We present our preferred surgical approach for acute as well as chronic SCJ dislocations, including their outcome. METHODS Five consecutive male patients with a median age of 27 (range 20-49) were treated for traumatic anterior (n = 2) or posterior (n = 3) SCJ dislocation. Open reduction and surgical fixation were achieved by a modified figure-of-eight sutures using Fiberwire®. In anterior dislocations, an additional reconstruction of the costoclavicular ligament was performed. Median follow-up was 11 months (range 9-48) and included clinical evaluation and the use of the DASH questionnaire. RESULTS Open surgical reduction and SCJ repair were successfully achieved in all patients without complications. Repair resulted in very good functional outcomes in all five patients with DASH scores of 0, 8 (n = 3) and 5, 8 (n = 2), respectively. CONCLUSIONS The presented technique allowed simple, effective, and durable repair of the SCJ joint in patients with SCJ dislocations with excellent functional outcomes.
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29
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Willinger L, Schanda J, Herbst E, Imhoff AB, Martetschläger F. Outcomes and complications following graft reconstruction for anterior sternoclavicular joint instability. Knee Surg Sports Traumatol Arthrosc 2016; 24:3863-3869. [PMID: 26334885 DOI: 10.1007/s00167-015-3770-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 08/20/2015] [Indexed: 01/25/2023]
Abstract
PURPOSE Publications describing tendon graft reconstruction for anterior sternoclavicular joint (SCJ) instability are rare and usually refer to small patient numbers. The aim of this study was to systematically review the literature regarding outcomes and complications following tendon graft reconstruction techniques for anterior SCJ instability. METHODS An online database was systematically searched to identify studies on graft reconstruction for anterior SCJ instability. Reported outcome scores were graded as excellent, good, fair and poor to summarize the study results. All reported complications were recorded. RESULTS Five articles with a total of 80 patients met the inclusion criteria. Reported outcomes were excellent in 10 %, good in 89 % and fair in 1 %. Recurrent instability was found in 10 % of the patients, and 5 % underwent revision surgery due to persistent impairment of shoulder function related to SCJ instability or osteoarthritis. CONCLUSION Surgical stabilization techniques for the SCJ using autologous tendon grafts have shown to be safe and reliable and make better patients' pain situation and shoulder function. However, a certain amount of impairment might persist, which needs to be discussed with patients. Severe complications were rare and revision rates were as low as 5 %. Therefore, graft reconstruction techniques should be considered for patients with chronic anterior SCJ instability after a course of failed conservative treatment. This study is valuable for clinicians in daily clinical practice when dealing with this difficult-to-treat pathology and can help surgeons to better predict the clinical outcomes and complications following SCJ graft reconstruction. It should, however, not lead to underestimation of the potential risks of the procedure. LEVEL OF EVIDENCE Systematic review, Level IV.
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Affiliation(s)
- Lukas Willinger
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Jakob Schanda
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Elmar Herbst
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Frank Martetschläger
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.,Deutsches Schulterzentrum, ATOS Clinic Munich, Effnerstr. 38, 81925, Munich, Germany
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30
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Chen H, Ji X, Hao M, Zhang Q, Tang P. A three-stage procedure using bone transportation for the treatment of sternoclavicular infectious arthritis. J Orthop Surg Res 2016; 11:152. [PMID: 27884200 PMCID: PMC5123358 DOI: 10.1186/s13018-016-0480-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background Sternoclavicular joint (SCJ) infectious arthritis is a rare disease. A standard treatment for SCJ infection has not been established. This study aimed to assess the clinical outcomes of a three-stage procedure with bone transportation (BT) for treating SCJ infectious arthritis. Methods Six patients (mean age 39.5 years) with chronic SCJ infectious arthritis were included in the study. The patients underwent a three-stage treatment between January 2009 and December 2012, and results were analyzed retrospectively. Following debridement, immediate flap closure was conducted, and BT of the clavicle was performed to fill the gap using a monolateral external fixator. SCJ reconstruction with a tendon autograft was performed, and the external fixator was finally removed. Clinical outcomes were evaluated using Disabilities of the Arm, Shoulder, and Hand (DASH) scores and Constant scores. The average follow-up period was 16 months (range 12–36 months). Results The DASH scores decreased from 53.6 ± 4.9 preoperatively to 24.4 ± 3.1 postoperatively. The Constant scores for pain, activity level, positioning, strength, and range of motion were significantly high after the treatment. The total Constant score improved from 32.5 ± 5.8 preoperatively to 76.7 ± 6.4 postoperatively. All patients were satisfied with the therapeutic effect. No complications occurred. Conclusions The three-stage procedure with BT improves shoulder function and movement and relieves pain. It is an effective and safe method for treating SCJ infectious arthritis.
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Affiliation(s)
- Hua Chen
- Department of Orthopaedics Surgery, General Hospital of PLA, Fuxinglu 28, Haidian District, Beijing, 100853, China
| | - Xinran Ji
- Department of Orthopaedics Surgery, General Hospital of PLA, Fuxinglu 28, Haidian District, Beijing, 100853, China
| | - Ming Hao
- Department of Orthopaedics Surgery, General Hospital of PLA, Fuxinglu 28, Haidian District, Beijing, 100853, China
| | - Qun Zhang
- Department of Orthopaedics Surgery, General Hospital of PLA, Fuxinglu 28, Haidian District, Beijing, 100853, China.
| | - Peifu Tang
- Department of Orthopaedics Surgery, General Hospital of PLA, Fuxinglu 28, Haidian District, Beijing, 100853, China.
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31
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Novel technique for sternoclavicular joint reconstruction using a gracilis tendon autograft. Knee Surg Sports Traumatol Arthrosc 2016; 24:2225-30. [PMID: 25758984 DOI: 10.1007/s00167-015-3570-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED Surgical treatment of sternoclavicular joint instability can be challenging and carries the inherent risk of damaging vital structures if the posterior capsule is violated during surgery. In the current manuscript, a novel and easy technique for open reduction and tendon graft stabilization of the unstable sternoclavicular joint is presented. Analogous to other techniques, the graft is passed through drill holes in a figure-of-eight configuration. However, for this technique, the drill holes are placed in oblique direction from the anterior cortex towards the articular surface of the sternum, respectively the medial clavicle. By doing so, graft reconstruction is achieved without any need for retrosternal dissection and mobilization of the posterior capsule, thus minimizing the risk of severe intraoperative complications. LEVEL OF EVIDENCE V.
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Morell DJ, Thyagarajan DS. Sternoclavicular joint dislocation and its management: A review of the literature. World J Orthop 2016; 7:244-250. [PMID: 27114931 PMCID: PMC4832225 DOI: 10.5312/wjo.v7.i4.244] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/13/2015] [Accepted: 01/07/2016] [Indexed: 02/06/2023] Open
Abstract
Dislocations of the sternoclavicular joint (SCJ) occur with relative infrequency and can be classified into anterior and posterior dislocation, with the former being more common. The SCJ is inherently unstable due to its lack of articular contact and therefore relies on stability from surrounding ligamentous structures, such as the costoclavicular, interclavicular and capsular ligaments. The posterior capsule has been shown in several studies to be the most important structure in determining stability irrespective of the direction of injury. Posterior dislocation of the SCJ can be associated with life threatening complications such as neurovascular, tracheal and oesophageal injuries. Due to the high mortality associated with such complications, these injuries need to be recognised acutely and managed promptly. Investigations such as X-ray imaging are poor at delineating anatomy at the level of the mediastinum and therefore CT imaging has become the investigation of choice. Due to its rarity, the current guidance on how to manage acute and chronic dislocations is debatable. This analysis of historical and recent literature aims to determine guidance on current thinking regarding SCJ instability, including the use of the Stanmore triangle. The described methods of reduction for both anterior and posterior dislocations and the various surgical reconstructive techniques are also discussed.
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Sternoclavicular Reconstruction in the Young Active Patient: Risk Factor Analysis and Clinical Outcomes at Short-Term Follow-up. J Orthop Trauma 2016; 30:e111-7. [PMID: 26569185 DOI: 10.1097/bot.0000000000000483] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the functional outcomes in young, active individuals after sternoclavicular (SC) joint reconstruction. DESIGN Level IV, case series. SETTING United States military hospitals, 2008-2012. PATIENTS/PARTICIPANTS Retrospective review of all consecutive patients from the Military Health System Management Analysis and Reporting Tool was performed. Patients who underwent other open-shoulder procedures (eg, acromioclavicular joint reconstruction), those of nonmilitary or retired status, and patients with under 12-month minimum follow-up without medical separation were excluded from further analysis. INTERVENTION Open reconstruction of SC joint dislocation. MAIN OUTCOME MEASURES Primary outcomes of interest were clinical failure and medical separation due to persistent shoulder girdle dysfunction. Demographic data, surgical technique, outcomes, complications, and occupational military outcomes were recorded. RESULTS Fourteen patients, with an average age of 26 years, experienced 8 anterior (57.1%) and 6 posterior (42.9%) SC joint dislocations. Four patients (28.6%) presented with dysphagia or dyspnea, and 10 patients (71.4%) had a missed diagnosis with an average of 13 months until diagnosis. Twelve of 14 (85.7%) patients underwent figure-of-eight tendon reconstruction, and 10 (71.4%) were able to return to full active military duty at an average 26.8 ± 12.9 months follow-up. There were 6 complications in 5 patients (35.7%), whereas 2 (14.3%) reported persistent instability and 2 (14.3%) required reoperation. CONCLUSIONS SC joint dislocations are rare injuries that are frequently missed on clinical presentation in this study. However, acute or delayed surgical reconstruction may afford predictable rates of return to function in young active military service members. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Petri M, Greenspoon JA, Horan MP, Martetschläger F, Warth RJ, Millett PJ. Clinical outcomes after autograft reconstruction for sternoclavicular joint instability. J Shoulder Elbow Surg 2016; 25:435-41. [PMID: 26632097 DOI: 10.1016/j.jse.2015.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/31/2015] [Accepted: 08/09/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Instability of the sternoclavicular (SC) joint is a rare condition. However, in some cases, SC joint instability may lead to persistent pain and impairment of shoulder function that requires surgical management. This study evaluated clinical outcomes after SC joint reconstruction with hamstring tendon autograft in patients with SC joint instability. METHODS From December 2010 to January 2014, 21 reconstructions of the SC joint with hamstring tendon autograft were performed. Outcomes data were prospectively collected and retrospectively reviewed. Data analyzed included American Shoulder and Elbow Surgeons score, Quick Disability of the Arm, Shoulder and Hand, physical component of the Short Form 12, and Single Assessment Numeric Evaluation scores. Pain with activities of daily living, work, and sleep were separately analyzed along with painless use of arm for activities. Patients were also questioned regarding postoperative satisfaction. RESULTS Nine women and 10 men (2 bilaterals), with a mean age of 30 years (range, 15-56 years), were monitored for a mean of 2 years (range, 12-36 months) postoperatively. Mean American Shoulder and Elbow Surgeons, Quick Disability of the Arm, Shoulder and Hand, and Single Assessment Numeric Evaluation scores significantly improved (P < .001). Pain scores also improved over preoperative baselines, including pain with activities of daily living, work, and sleep (P < .001). Median satisfaction at final follow-up was 8.5 (range, 7-10). There were no intraoperative or postoperative complications and no cases of recurrent instability. CONCLUSION Free hamstring tendon autograft reconstruction for SC joint instability resulted in significantly improved clinical outcomes with high patient satisfaction and no intraoperative or postoperative complications.
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Affiliation(s)
- Maximilian Petri
- The Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | | | | | - Frank Martetschläger
- The Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA; Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany; Department of Orthopaedic Sports Medicine, Clinic rechts der Isar, Technical University Munich, Munich, Germany
| | - Ryan J Warth
- The Steadman Philippon Research Institute, Vail, CO, USA
| | - Peter J Millett
- The Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA.
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Incidence, characteristics, and long-term follow-up of sternoclavicular injuries. J Trauma Acute Care Surg 2016; 80:289-95. [DOI: 10.1097/ta.0000000000000888] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rutkowski SP, Grote S, Flatz W, Haasters F, Böcker W, Ockert B. [Acute posterior dislocation of the sternoclavicular joint: Reduction, fixation by endobutton system and alternative procedures]. Unfallchirurg 2015; 119:346-52. [PMID: 26597194 DOI: 10.1007/s00113-015-0095-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Acute posterior dislocation of the sternoclavicular (SC) joint is rare but can lead to life-threatening vascular injuries of the mediastinum; however, diagnosis is difficult and the injury can be initially overlooked so that surgical treatment is delayed. Although a variety of different treatment modalities have been published, the ideal fixation technique has not yet been identified. We report the case of a patient suffering from a locked posterior SC joint dislocation caused by a skiing accident. The injury was treated by transarticular endobutton fixation. This article describes the technique and highlights its advantages and disadvantages in comparison to previously published treatment options.
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Affiliation(s)
- S P Rutkowski
- Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie - Campus Großhadern, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - S Grote
- Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie - Campus Großhadern, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - W Flatz
- Institut für Klinische Radiologie, Klinikum der Universität München, München, Deutschland
| | - F Haasters
- Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie - Campus Großhadern, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - W Böcker
- Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie - Campus Großhadern, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - B Ockert
- Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie - Campus Großhadern, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
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Abstract
Posterior sternoclavicular joint injuries are increasingly diagnosed in children and young adults. Most of these injuries are the result of indirect mechanisms, typically lateral compression, with a posterior-to-anterior force applied to the shoulder during sports. Less frequently, these injuries are caused by direct impact on the medial clavicle, which can occur in rollover motor vehicle accidents, or may represent atraumatic instability. In patients younger than 25 years, physeal separation is more common than true dislocation. Theoretically, these patients have increased remodeling potential. Reduction is recommended to prevent and/or manage the compression of mediastinal structures, which can lead to life-threatening injury. Open surgical stabilization is the preferred treatment for acute and chronic retrosternal injuries. A thoracic or trauma surgeon should be available during stabilization in the rare event of potentially life-threatening hemorrhage after reduction. Outcomes have been largely successful, with pain-free, unrestricted range of motion and return to activity.
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Terra BB, Rodrigues LM, Pádua DVH, Martins MG, Teixeira JCDM, De Nadai A. Luxação esternoclavicular: relato de caso e técnica cirúrgica. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2014.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Terra BB, Rodrigues LM, Pádua DVH, Martins MG, Teixeira JCDM, De Nadai A. Sternoclavicular dislocation: case report and surgical technique. Rev Bras Ortop 2015; 50:472-7. [PMID: 26401506 PMCID: PMC4563050 DOI: 10.1016/j.rboe.2015.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 07/29/2014] [Indexed: 11/06/2022] Open
Abstract
Sternoclavicular dislocations account for less than 5% of all dislocations of the scapular belt. Most cases of anterior dislocation of the sternoclavicular joint do not present symptoms. However, some patients may develop chronic anterior instability and remain symptomatic, and surgical treatment is indicated in these cases. There is a scarcity of reports in the literature relating to reconstruction using the long palmar tendon in cases of traumatic anterior instability. Although rare, these injuries deserve rapid diagnosis and efficient treatment in order to avoid future complications. The aim of this report was to report on a case of a motocross competitor who developed chronic traumatic anterior instability of the sternoclavicular joint and underwent surgical reconstruction using the autogenous long palmar tendon. The patient was a 33-year-old man with a history of anterior dislocation of the sternoclavicular subsequent to a fall during a maneuver in a motocross competition. Conservative treatment was instituted initially, consisting of use of a functional sling to treat the symptoms for 3 weeks, along with physiotherapeutic rehabilitation for 3 months. We chose to use a modification of the “figure of eight” technique based on the studies by Spencer and Kuhn. A longitudinal incision of approximately 10 cm was made at the level of the sternoclavicular joint. The graft from the ipsilateral long palmar tendon was passed through the orifices in the form of a modified “figure of eight” and its ends were sutured together. The patient was immobilized using an American sling for 4 weeks. After 6 months of follow-up, the patient no longer presented pain or instability when movement of the sternoclavicular joint was required. Minor discomfort and slight prominence of the sternoclavicular joint continued to be present but did not affect the patient's activities. Thus, the patient was able to return to racing 6 months after the operation. Our study presented a case of chronic anterior dislocation of the sternoclavicular joint that was successfully treated by using a modification of the “figure of eight” reconstruction technique. This technique was shown to be safe and effective, and it allowed the patient to fully return to his sports activities.
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Kawaguchi K, Tanaka S, Yoshitomi H, Nagai I, Sato W, Karita T, Kondo T. Double figure-of-eight reconstruction technique for chronic anterior sternoclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 2015; 23:1559-1562. [PMID: 24722676 DOI: 10.1007/s00167-014-2979-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/30/2014] [Indexed: 10/25/2022]
Abstract
Sternoclavicular joint dislocations account for <5 % of all dislocations of the shoulder girdle. Whereas most cases of anterior dislocation do not experience symptoms, some patients with anterior instability remain symptomatic and require reconstructive surgery to stabilize the sternoclavicular joint. We present the case of a 57-year-old male diagnosed with sternoclavicular joint anterior dislocation and unusual swallowing difficulty while bending the neck forward. The patient was treated using a new and effective surgical technique of sternoclavicular joint reconstruction named "double figure-of-eight" using the ipsilateral gracilis tendon. Surgical outcome was successful, based on the Rockwood SC joint rating scale, and the patient maintained excellent stability even after 2 years. This new surgical technique offers superior stability, without harvest site morbidity, to patients with rare, severe, and chronic sternoclavicular joint dislocation. Level of evidence IV.
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Affiliation(s)
- Kohei Kawaguchi
- Department of Orthopaedics Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, Japan.
| | - Sayo Tanaka
- Department of Orthopaedics Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, Japan
| | - Hiroki Yoshitomi
- Department of Orthopaedics Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, Japan
| | - Ichiro Nagai
- Department of Orthopaedics Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, Japan
| | - Wakyo Sato
- Department of Orthopaedics Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, Japan
| | - Tasturo Karita
- Department of Orthopaedics Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, Japan
| | - Taiji Kondo
- Department of Orthopaedics Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, Japan
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Thyagarajan D, Webb M, Wallace A. A rare case of floating clavicle and a novel technique for stabilizing the sternoclavicular joint. Shoulder Elbow 2015; 7:44-8. [PMID: 27582956 PMCID: PMC4935098 DOI: 10.1177/1758573214536534] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 04/09/2014] [Indexed: 02/05/2023]
Abstract
We present the first ever case report of a floating clavicle with a unique combination of a posterior sternoclavicular joint dislocation and an associated grade III acromioclavicular joint dislocation. We treated this injury surgically by stabilizing both ends of clavicle using a polyester surgical mesh device (LockDown™; Mandaco 569 Limited, Redditch, UK; previously called the Nottingham Surgilig).
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Affiliation(s)
| | - Mark Webb
- Countess of Chester Hospital, Chester, UK
| | - Angus Wallace
- Nottingham Shoulder & Elbow Unit, Nottingham City Hospital, Nottingham, UK
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Negri JH, Malavolta EA, Assunção JH, Gracitelli MEC, Pereira CAM, Bolliger Neto R, Croci AT, Ferreira Neto AA. Assessment of the function and resistance of sternoclavicular ligaments: A biomechanical study in cadavers. Orthop Traumatol Surg Res 2014; 100:727-31. [PMID: 25261174 DOI: 10.1016/j.otsr.2014.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 05/05/2014] [Accepted: 07/31/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Few biomechanical studies have assessed the resistance of the ligamentous structures of the sternoclavicular joint, and none have reproduced the physiological movements of the joint. Determining the structures that are injured in sternoclavicular dislocations is important for the surgical planning of acute or chronic ligament reconstruction. METHODS Forty-eight joints from 24 human cadavers were studied, and they were divided into 4 groups of 12 joints each (retraction, protraction, depression and elevation). Biomechanical testing assessed primary and secondary failures. The mechanical resistance parameters between movements that occurred on the same plane (depression versus elevation, protraction versus retraction) were compared. RESULTS The posterior sternoclavicular ligament was the most injured structure during the protraction test, but it was not injured during retraction. The anterior sternoclavicular ligament was the most affected structure during retraction and depression. The costoclavicular ligament was the most affected structure during elevation. Joint resistance was significantly greater during protraction movements when compared to retraction (P<0.05). CONCLUSION The anterior sternoclavicular ligament was the most affected structure during retraction and depression movements. During protraction, lesions of the posterior sternoclavicular ligament were most frequent during elevation, and the costoclavicular ligament was the most frequently injured ligament. The resistance of the sternoclavicular joint was significantly greater during protraction movement when compared to retraction. LEVEL OF EVIDENCE IV, basic science, biomechanics, cadaver model.
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Affiliation(s)
- J H Negri
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - E A Malavolta
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - J H Assunção
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil.
| | - M E C Gracitelli
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - C A M Pereira
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - R Bolliger Neto
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - A T Croci
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - A A Ferreira Neto
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
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Tepolt F, Carry PM, Heyn PC, Miller NH. Posterior sternoclavicular joint injuries in the adolescent population: a meta-analysis. Am J Sports Med 2014; 42:2517-24. [PMID: 24569702 DOI: 10.1177/0363546514523386] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sternoclavicular dislocations are relatively infrequent and are generally divided into anterior and posterior disruptions, the former being the most common. While posterior sternoclavicular joint (PSCJ) injuries are very rare, they may be associated with life-threatening complications. The ideal management of these injuries, particularly in the adolescent population, has not been well described. PURPOSE Through a meta-analysis of PSCJ injuries in the adolescent, we aimed to (1) describe the epidemiology of PSCJ injuries in relation to the mechanism of injury, associated complications, and treatment preferences; (2) compare the success of closed reduction when attempted <48 versus >48 hours after the initial injury; and (3) compare the outcomes of closed versus open treatment. STUDY DESIGN Meta-analysis. METHODS A thorough review of the English literature was performed to identify all cases of PSCJ dislocations or medial clavicular physeal fractures in patients aged 12 to 18 years. Patient-level data for 140 patients were extracted from 79 studies. RESULTS The mean age of the patients was 15.24 years. Forty-nine patients (35.00%) underwent closed treatment only, 42 (30.00%) open treatment alone, and 47 (33.57%) closed treatment followed by open treatment. Also, 55.8% of closed reductions performed within 48 hours were successful compared with 30.8% of those performed more than 48 hours after injury. After initial treatment, 92.31% of patients treated with closed reduction regained full function without recurrence as compared with 95.83% of patients treated operatively. CONCLUSION Closed and open methods have proven highly effective for the treatment of PSCJ injuries. However, follow-up data reported in the literature vary considerably. Closed reduction is most effective when attempted less than 48 hours after the initial injury.
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Warth RJ, Lee JT, Millett PJ. Figure-of-Eight Tendon Graft Reconstruction for Sternoclavicular Joint Instability: Biomechanical Rationale, Surgical Technique, and a Review of Clinical Outcomes. OPER TECHN SPORT MED 2014. [DOI: 10.1053/j.otsm.2013.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Martetschläger F, Warth RJ, Millett PJ. Instability and degenerative arthritis of the sternoclavicular joint: a current concepts review. Am J Sports Med 2014; 42:999-1007. [PMID: 23956132 DOI: 10.1177/0363546513498990] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injuries to the sternoclavicular (SC) joint typically occur with high-energy mechanisms such as those obtained in automobile accidents or contact sports. Many disorders of the SC joint can be treated nonoperatively. However, surgical treatment may be indicated for locked posterior dislocations; symptomatic, chronic instability; or persistent, painful osteoarthritis that fails nonoperative therapy. PURPOSE To provide an updated review on the current diagnosis and management of instability and degenerative arthritis of the SC joint. STUDY DESIGN Current concepts review. METHODS A preliminary PubMed database search using the terms sternoclavicular instability, dislocation, arthritis, resection, and stabilization was performed in August 2012. All anatomic and biomechanical studies, review articles, case reports, case series, and technique papers that were relevant to the topic were included. RESULTS The search identified 929 articles, 321 of which, after screening of the titles and abstracts, were considered potentially relevant to this study. Of the 321 articles, 30 were anatomic or imaging studies, 2 were biomechanical studies, 69 were review papers, 189 were case series or reports, and 31 were technique papers. The majority of these studies were classified as evidence level 4, with a few scattered level 3 studies. Because the level of evidence obtained from this search was not adequate for systematic review (or meta-analysis), a current concepts review of the diagnosis and management of SC joint instability and degenerative arthritis is presented. CONCLUSION Injuries to the SC joint are uncommon. Recognition and classification of these injuries are critical to proper management, thus minimizing potential long-term sequelae such as posttraumatic arthritis and recurrent instability. Although nonoperative therapy is the modality of choice in anterior dislocations, posterior dislocations require special attention because of the presence of vulnerable posterior hilar structures. Surgical management of chronic instability and degenerative arthritis of the SC joint includes resection arthroplasty of the medial clavicle with or without reconstruction of the sternoclavicular ligaments with graft material. Although resection is typically performed open, an arthroscopic technique is described that theoretically decreases operating and recovery times while also decreasing the risk of iatrogenic injury. Currently, when reconstruction is needed for stability, a figure-of-8 graft reconstruction is the recommended method based on biomechanical data and small clinical series.
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Affiliation(s)
- Frank Martetschläger
- Peter J. Millett, Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657.
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Deren ME, Behrens SB, Vopat BG, Blaine TA. Posterior sternoclavicular dislocations: a brief review and technique for closed management of a rare but serious injury. Orthop Rev (Pavia) 2014; 6:5245. [PMID: 24744842 PMCID: PMC3980158 DOI: 10.4081/or.2014.5245] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/20/2014] [Indexed: 11/23/2022] Open
Abstract
Posterior sternoclavicular dislocations are rare but serious injuries. The proximity of the medial clavicle to the vital structures of the mediastinum warrants caution with management of the injury. Radiographs are the initial imaging test, though computed tomography and magnetic resonance imaging are essential for diagnosis and preoperative planning. This paper presents an efficient diagnostic approach and effective technique of closed reduction of posterior sternoclavicular dislocations with a brief review of open and closed reduction procedures.
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Affiliation(s)
- Matthew E Deren
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University , Providence, RI, USA
| | - Steve B Behrens
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University , Providence, RI, USA
| | - Bryan G Vopat
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University , Providence, RI, USA
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Uri O, Barmpagiannis K, Higgs D, Falworth M, Alexander S, Lambert SM. Clinical outcome after reconstruction for sternoclavicular joint instability using a sternocleidomastoid tendon graft. J Bone Joint Surg Am 2014; 96:417-22. [PMID: 24599204 DOI: 10.2106/jbjs.m.00681] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior instability of the sternoclavicular joint is uncommon and usually follows a benign course, although symptomatic patients may require surgical intervention. The optimal treatment for symptomatic instability of the sternoclavicular joint remains unclear. The aim of this study was to evaluate the clinical outcome after reconstruction of the sternoclavicular joint with use of a sternocleidomastoid tendon graft to treat chronic debilitating anterior instability of the sternoclavicular joint. METHODS Thirty-two patients underwent surgical reconstruction of the sternoclavicular joint for chronic debilitating anterior instability using the tendon of the sternal head of the ipsilateral sternocleidomastoid muscle and were followed for a mean of forty-four months. The etiology of instability was posttraumatic in fourteen patients, generalized hyperlaxity in seven patients, and degenerative instability in eleven patients. Outcome measures included the Oxford instability shoulder score, subjective shoulder value, pain rating, and postoperative grading of sternoclavicular joint stability. RESULTS Clinical scores and pain rating were similar for the three groups before surgery and improved significantly in all of the groups to the same extent after the surgery. At the time of the latest follow-up, eleven of fourteen patients in the posttraumatic group, six of seven patients in the generalized hyperlaxity group, and eight of eleven patients in the degenerative group reported the sternoclavicular joint as stable with no functional limitation. Two patients reported that the joint remained unstable. No other complications occurred. CONCLUSIONS Sternoclavicular joint reconstruction using a sternocleidomastoid tendon graft is safe and offers reliable pain relief and functional improvement for patients with chronic debilitating anterior instability of the sternoclavicular joint.
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Affiliation(s)
- Ofir Uri
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for O. Uri:
| | - Konstantinos Barmpagiannis
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for O. Uri:
| | - Deborah Higgs
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for O. Uri:
| | - Mark Falworth
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for O. Uri:
| | - Susan Alexander
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for O. Uri:
| | - Simon M Lambert
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for O. Uri:
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Bak K, Fogh K. Reconstruction of the chronic anterior unstable sternoclavicular joint using a tendon autograft: medium-term to long-term follow-up results. J Shoulder Elbow Surg 2014; 23:245-50. [PMID: 23849677 DOI: 10.1016/j.jse.2013.05.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 04/21/2013] [Accepted: 05/02/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic symptomatic anterior sternoclavicular (SC) instability is a rare condition with sparse treatment options. Owing to the rarity of the condition and the potential risk of fatal complications, only a few reports on treatment of this condition have been published. We evaluated a prospective series of patients with chronic anterior SC instability who underwent minimally open reconstruction with an autologous tendon graft. METHODS From 2002 to 2010, 32 consecutive patients underwent minimally open SC ligament reconstruction using a tendon autograft. A palmaris longus was used in 7 patients and a gracilis tendon autograft was used in 25. All patients with at least 2 years of follow-up were reviewed. Five were lost to follow-up. The remaining 27 patients (84.4%) were a median age of 35 years (range, 11-61 years) at surgery. Patients were evaluated with the Western Ontario Shoulder Instability (WOSI) score preoperatively and at follow-up at a median 54 months (range, 24-120 months) postoperatively. RESULTS The total WOSI score improved from a median of 44% (range 6%-62%) preoperatively to 75% (range, 13%-93%) at follow-up (P = .0001). Two failures (7.4%) occurred; after revision, both patients remained stable. After the operation, 17 of 25 patients (68%) complained of donor site morbidity, and 10 (40%) still had some discomfort at follow-up. No infections or local vascular complications occurred. CONCLUSIONS Miniopen SC joint reconstruction using a tendon autograft results in prolonged improvement in shoulder function in most patients with symptomatic anterior SC instability.
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Affiliation(s)
- Klaus Bak
- Parkens Privathospital, Copenhagen, Denmark.
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49
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Sewell MD, Al-Hadithy N, Le Leu A, Lambert SM. Instability of the sternoclavicular joint: current concepts in classification, treatment and outcomes. Bone Joint J 2013; 95-B:721-31. [PMID: 23723264 DOI: 10.1302/0301-620x.95b6.31064] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The sternoclavicular joint (SCJ) is a pivotal articulation in the linked system of the upper limb girdle, providing load-bearing in compression while resisting displacement in tension or distraction at the manubrium sterni. The SCJ and acromioclavicular joint (ACJ) both have a small surface area of contact protected by an intra-articular fibrocartilaginous disc and are supported by strong extrinsic and intrinsic capsular ligaments. The function of load-sharing in the upper limb by bulky periscapular and thoracobrachial muscles is extremely important to the longevity of both joints. Ligamentous and capsular laxity changes with age, exposing both joints to greater strain, which may explain the rising incidence of arthritis in both with age. The incidence of arthritis in the SCJ is less than that in the ACJ, suggesting that the extrinsic ligaments of the SCJ provide greater stability than the coracoclavicular ligaments of the ACJ. Instability of the SCJ is rare and can be difficult to distinguish from medial clavicular physeal or metaphyseal fracture-separation: cross-sectional imaging is often required. The distinction is important because the treatment options and outcomes of treatment are dissimilar, whereas the treatment and outcomes of ACJ separation and fracture of the lateral clavicle can be similar. Proper recognition and treatment of traumatic instability is vital as these injuries may be life-threatening. Instability of the SCJ does not always require surgical intervention. An accurate diagnosis is required before surgery can be considered, and we recommend the use of the Stanmore instability triangle. Most poor outcomes result from a failure to recognise the underlying pathology. There is a natural reluctance for orthopaedic surgeons to operate in this area owing to unfamiliarity with, and the close proximity of, the related vascular structures, but the interposed sternohyoid and sternothyroid muscles are rarely injured and provide a clear boundary to the medial retroclavicular space, as well as an anatomical barrier to unsafe intervention. This review presents current concepts of instability of the SCJ, describes the relevant surgical anatomy, provides a framework for diagnosis and management, including physiotherapy, and discusses the technical challenges of operative intervention.
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Affiliation(s)
- M D Sewell
- The Shoulder & Elbow Service, The Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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50
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Gardeniers JWM, Burgemeester J, Luttjeboer J, Rijnen WHC. Surgical technique: Results of stabilization of sternoclavicular joint luxations using a polydioxanone envelope plasty. Clin Orthop Relat Res 2013; 471:2225-30. [PMID: 23460487 PMCID: PMC3676619 DOI: 10.1007/s11999-013-2890-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 02/21/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical treatment options for sternoclavicular joint luxations described in the literature are numerous, although all have limitations. Therefore, there is no favorable surgical treatment for sternoclavicular luxations when nonoperative treatment has failed. DESCRIPTION OF TECHNIQUE We developed the polydioxanone (PDS) envelope plasty, a modification of the figure-of-eight technique, using a PDS ligament. METHODS We retrospectively reviewed 39 patients (40 joints), treated with a PDS envelope plasty for invalidating sternoclavicular luxations. The minimum followup was 10 months (average, 52 months; range, 10-171 months). The Simple Shoulder Test (SST), Constant-Murley shoulder score, and subjective categorical results were recorded preoperatively and postoperatively. RESULTS In most patients, postoperative functional shoulder scores were excellent (mean Constant-Murley score, 90, range, 52-100; mean SST, 10; range, 2-12). Ninety percent of patients had an improvement of shoulder function at followup. Only minor complications occurred. Thirteen percent of patients had spontaneous postoperative subluxations. However, the postoperative shoulder function improved in all these patients. CONCLUSIONS The PDS envelope plasty is a simple procedure, a modification of the best-reported technique. We have promising results with high shoulder scores. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jean W M Gardeniers
- Department of Orthopaedics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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