1
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Somerson JS, Parker KM, Warme WJ. Sternoclavicular joint reconstruction for traumatic acute and chronic anterior and posterior instability: Patient-reported outcomes at a minimum of 2 years. Shoulder Elbow 2024; 16:68-75. [PMID: 38435036 PMCID: PMC10902419 DOI: 10.1177/17585732231209967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/09/2023] [Accepted: 10/09/2023] [Indexed: 03/05/2024]
Abstract
Background Instability of the sternoclavicular joint (SCJ) is a rare problem that is often treated closed, with few published outcomes of surgical treatment with tendon graft reconstruction. Methods We reviewed a consecutive series of patients who underwent tendon graft reconstruction for SCJ instability over a 7-year period. Cases with acute fractures or fewer than 2 years of follow-up were excluded. Pre- and postoperative function and pain were assessed using Single assessment numeric evaluation (SANE), simple shoulder test (SST), and visual analog scale (VAS) outcome measures. Results Thirty cases were included, with 27 (90%) available for follow-up at a minimum of 2 years postoperatively. SANE scores improved from a median of 40 to 90. SST scores improved from a median of 3 positive responses to a median of 12 on a 12-point scale. VAS scores decreased from a median of 7 to 0 points. One patient underwent reoperation for recurrent instability and wound dehiscence. Three (11%) patients did not achieve a minimum 30% of maximum possible improvement in SST scores. Conclusions Tendon graft reconstruction for SCJ instability is a safe procedure with a low complication rate and statistically and clinically significant improvements in patient-reported outcome measures at 2-year minimum follow-up. Level of evidence Level IV: Therapeutic.
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Affiliation(s)
- Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Kate M Parker
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Winston J Warme
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
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2
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Xin H, Wang X, Zhang S, Lin L, Chen H, Hong H. Novel sternoclavicular hook plate for the treatment of posterior sternoclavicular dislocation: a retrospective study. J Orthop Surg Res 2023; 18:945. [PMID: 38071288 PMCID: PMC10709940 DOI: 10.1186/s13018-023-04436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Controversies regarding the optimal internal fixation method for posterior sternoclavicular dislocation (SCD) exist. Therefore, this study aimed to investigate the clinical efficacy of a new type of sternoclavicular hook plate for treating posterior SCD. METHODS Eleven patients (eight men and three women) with posterior SCD who underwent treatment with the new sternoclavicular hook plate from June 2011 to January 2022 were retrospectively analyzed. The patients' ages ranged from 33 to 71 years (54.91 ± 13.58 years). Operation time, blood loss, length of hospital stay, and postoperative complications were recorded. Postoperative joint reduction and healing were evaluated using radiography and computed tomography. The Constant-Murley and Rockwood sternoclavicular joint scores were used to evaluate the functional recovery of the affected limb 12 months after surgery. RESULTS All 11 patients were followed up for 12-24 months (18.00 ± 3.74 months). All incisions healed by first intention. The healing time ranged from 9 to 13 days (10.82 ± 1.54 days), and the joint healing time was 3-4 months (3.55 ± 0.52 months). The operation time was 45-75 min (59.55 ± 11.06 min), intraoperative blood loss was 22-58 mL (39.91 ± 11.07 mL), and the length of hospitalization was 6-14 days (9.91 ± 3.27 days). There were no complications such as infections, internal fixation failure, or nerve injury. The Constant-Murley score was 93.64 ± 9.01 at 12 months postoperatively. The Rockwood score was 13.36 ± 1.86, of which nine cases were excellent, one case was good, and one case was fair. CONCLUSION The novel sternoclavicular hook plate is effective for the treatment of posterior SCD. This novel device can facilitate early joint functional exercises and good functional recovery.
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Affiliation(s)
- Hanlong Xin
- Department of Orthopaedic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Xingui Wang
- Department of Orthopaedic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Shaohua Zhang
- Intensive Care Unit (ICU), Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Lie Lin
- Department of Orthopaedic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Haixiao Chen
- Department of Orthopaedic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Huaxing Hong
- Department of Orthopaedic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China.
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3
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Gobbell W, Edwards CM, Engel SR, Coyner KJ. Atraumatic Sternoclavicular Joint Instability: Prevalence, Etiology, and Management. Clin Sports Med 2023; 42:723-737. [PMID: 37716734 DOI: 10.1016/j.csm.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Sternoclavicular joint instability is a rare complaint in the orthopedic clinic, but patients can experience chronic pain and functional impacts. Causes of instability may be posttraumatic, infectious, autoimmune, degenerative, or secondary to generalized laxity. Conservative treatment is the initial approach to management and involves activity modification, physical therapy, oral nonsteroidal anti-inflammatory drugs, and corticosteroid injections. Surgery is indicated when conservative treatment does not manage symptoms. Figure-of-eight reconstruction techniques provide greatest biomechanical strength but are associated with risk of neurovascular injury. Other reconstruction methods have been shown to mitigate these risks with favorable short-term outcomes.
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Affiliation(s)
- Wade Gobbell
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Christopher M Edwards
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Samuel R Engel
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Katherine J Coyner
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA.
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4
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Brown L, Tamburini LM. Traumatic Sternoclavicular Dislocations in Athletes: Diagnosis, Indications for Surgical Reconstruction, and Guide for Return to Play. Clin Sports Med 2023; 42:713-722. [PMID: 37716733 DOI: 10.1016/j.csm.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Injuries to the sternoclavicular (SC) joint are rare, however, when they occur prompt recognition, evaluation, and treatment are crucial. SC joint injuries can occur following high-energy mechanisms such as motor vehicle collisions and contact sports. Injury to the SC joint can be evaluated with the use of plain radiographs as well as computed tomography. If an injury to the SC joint is suspected, injury to vital mediastinal structures must be evaluated. SC joint dislocations can be treated by either closed reduction or open reduction and stabilization. Many stabilization methods have been described including plate stabilization and ligament reconstruction.
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Affiliation(s)
- Leah Brown
- Banner Orthopaedic Sports Medicine, University of Arizona College of Medicine-Phoenix, 7400 North Dobson Road, Scottsdale, AZ 85256, USA.
| | - Lisa M Tamburini
- Department of Orthopaedic Surgery, University of Connecticut, UConn Musculoskeletal Institute, 120 Dowling Way, Farmington, CT 06032, USA
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5
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Hesse D, Paull T, Cole PA. Current Concepts in Sternoclavicular Joint Injuries. J Orthop Trauma 2023; 37:e410-e415. [PMID: 37127896 DOI: 10.1097/bot.0000000000002625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/03/2023]
Abstract
LEVEL OF EVIDENCE Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniel Hesse
- Department of Orthopaedic Surgery, Regions Hospital, St Paul, MN
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6
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Schut SM, Shannon KN. Multimodal Chiropractic Management of a Postsurgical Sternoclavicular Injury Utilizing Gamified Rehabilitation: A Case Report. J Chiropr Med 2023; 22:230-233. [PMID: 37644998 PMCID: PMC10461152 DOI: 10.1016/j.jcm.2023.03.005] [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: 10/05/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 08/31/2023] Open
Abstract
Objective The purpose of this study was to describe how gamification was incorporated into postoperative rehabilitation of a patient recovering from a sternoclavicular dislocation. Clinical Features A 23-year-old man sought chiropractic care from an academic chiropractic clinic for persistent right-sided, sternoclavicular joint, moderate-to-severe pain that was exacerbated with shoulder movements and overhead activities. His shoulder was treated previously with reconstructive surgery and a 6-week trial of physical therapy; however, he reported minimal improvement in his pain, and his functional ability was suboptimal. Intervention and Outcome Multimodal chiropractic treatment consisted of manual therapy in conjunction with active rehabilitation. The rehabilitation program incorporated gamification principles, such as competition, point scoring, and task focus. After 8 treatments, a clinically significant reduction in his upper extremity functional index score and numerical pain rating was observed. Conclusion The patient was managed using a gamified approach to postsurgical sternoclavicular joint rehabilitation and responded positively. Chiropractors may consider including gamified, multimodal care for patients with postoperative musculoskeletal concerns.
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7
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Plath JE, Martetschläger F, Moroder P, Sandmann G. Instabilities and Osteoarthritis of the Sternoclavicular Joint. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023. [PMID: 37647924 DOI: 10.1055/a-2109-3190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Injury to the sternoclavicular joint (SCG) is very rare, accounting for 3% of shoulder injuries and < 1% of instabilities. Consequently, both the treatment of acute instabilities and their subsequent states (chronic instabilities/SCG arthrosis) are controversial. While treatment has so far been mostly conservative, in recent years there has been a trend towards surgical therapy.Considerable violence, such as that found in traffic accidents or contact sports, can tear the extremely stable ligaments between the medial clavicle and sternum. While anterior dislocation is easier to reduce in most cases, instability remains in up to 50% of cases. In most cases, posterior instability requires rapid reduction, particularly due to the anatomical proximity to important cardio-pulmonary structures. If this succeeds, the rate of persistent instabilities is low. For chronic instability, reconstruction/augmentation of the ligament apparatus with tendon grafts in the "Figure of 8 configuration" has proven to be the standard technique in recent years.
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Affiliation(s)
| | | | - Philipp Moroder
- Abteilung Schulterchirurgie und Ellenbogenchirurgie, Schulthess Klinik Zürich, Zürich, Schweiz
| | - Gunther Sandmann
- Sportklinik Ravensburg, Sportklinik Ravensburg, Ravensburg, Deutschland
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8
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Apostolakos JM, Jildeh TR, Dey Hazra RO, Dey Hazra ME, Chang PS, Geissbuhler AR, Rutledge JC, Millett PJ. Sternoclavicular Joint Reconstruction With Gracilis Tendon Autograft. Arthrosc Tech 2023; 12:e1281-e1288. [PMID: 37654872 PMCID: PMC10466140 DOI: 10.1016/j.eats.2023.03.019] [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] [Received: 01/04/2023] [Revised: 03/09/2023] [Accepted: 03/19/2023] [Indexed: 09/02/2023] Open
Abstract
Clinical instability of the sternoclavicular (SC) joint is a challenging problem. Recurrent subluxation and pain can lead to significant functional limitations. Although many patients respond positively to conservative treatment, chronic dislocations often require operative intervention. The complex anatomy of the diarthrodial SC joint and the existence of concomitant SC joint degenerative changes compounded with close-by neurovascular structures present a surgical challenge. The purpose of this Technical Note is to describe a technique for the open management of symptomatic sternoclavicular joint instability using a figure-of-8 reconstruction with a gracilis autograft. The present authors believe this technique provides a technically safe and reproducible method for reconstructing the SC joint without compromising biomechanical strength.
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Affiliation(s)
- John M. Apostolakos
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- The Steadman Clinic, Vail, Colorado, U.S.A
| | - Toufic R. Jildeh
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- The Steadman Clinic, Vail, Colorado, U.S.A
- Michigan State University, East Lansing, Michigan, U.S.A
| | | | | | - Peter S. Chang
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- The Steadman Clinic, Vail, Colorado, U.S.A
| | | | | | - Peter J. Millett
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- The Steadman Clinic, Vail, Colorado, U.S.A
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Romeo PV, Papalia AG, Gambhir N, Styles ST, Virk MS. Snapping Sternoclavicular Joint. Cureus 2023; 15:e38557. [PMID: 37288239 PMCID: PMC10241662 DOI: 10.7759/cureus.38557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
Snapping sternoclavicular joint (SCJ) is a rare presentation in the SCJ. We present a case report detailing the presentation and treatment of unilateral snapping SCJ in a 14-year-old male patient. Clinical findings included the subluxation of the medial end of the clavicle in the anterior-posterior direction following a specific maneuver by the patient that involved repetitive external rotation with the arm in horizontal abduction. Dynamic ultrasound demonstrated an asymmetric widening of the right sternoclavicular joint in the neutral position with a pronounced subluxation in provocative positioning. At 3.5-year follow-up, he continued to remain pain-free without static deformity of the SCJ. Snapping SCJ is a benign phenomenon that does not require any intervention and is not associated with ligament laxity.
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Affiliation(s)
- Paul V Romeo
- Department of Orthopedic Surgery, New York University (NYU) Langone Orthopedic Hospital, New York, USA
| | - Aidan G Papalia
- Department of Orthopedic Surgery, New York University (NYU) Langone Orthopedic Hospital, New York, USA
| | - Neil Gambhir
- Department of Orthopedic Surgery, New York University (NYU) Langone Orthopedic Hospital, New York, USA
| | - Stuart T Styles
- Department of Orthopedic Surgery, Somers Orthopedic Surgery and Sports Medicine Group, Carmel Hamlet, USA
| | - Mandeep S Virk
- Department of Orthopedic Surgery, New York University (NYU) Langone Orthopedic Hospital, New York, USA
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10
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Sternoclavicular Joint Instability and Reconstruction. J Am Acad Orthop Surg 2022; 30:e1076-e1083. [PMID: 35502995 DOI: 10.5435/jaaos-d-19-00611] [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] [Received: 03/04/2020] [Accepted: 03/20/2022] [Indexed: 02/01/2023] Open
Abstract
Chronic instability or degenerative arthritis of the sternoclavicular (SC) joint may occur after traumatic or spontaneous dislocation of the SC joint. Most commonly, chronic instability of the SC joint occurs anteriorly; however, posterior instability has an increased risk of serious complications because of proximity to mediastinal structures. Although chronic anterior instability of the SC joint does not resolve with nonsurgical treatment, patients often have mild symptoms that do not impair activities of daily living; however, chronic anterior SC joint instability may be functionally limiting in more active individuals. In these cases, surgical treatment with either (1) SC joint reconstruction or (2) medial clavicle resection, or both, can be done. Recurrent posterior instability of the SC joint also requires surgical treatment due to risk of injury to mediastinal structures. Recent literature describes various reconstruction techniques which generally show improved patient-reported outcomes and low complication rates.
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11
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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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12
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Obremskey WT, Rodriguez-Baron EB, Tatman LM, Pesantez RF. Acute Dislocations of the Sternoclavicular Joint: A Review Article. J Am Acad Orthop Surg 2022; 30:148-154. [PMID: 34898528 DOI: 10.5435/jaaos-d-20-01239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 11/01/2021] [Indexed: 02/01/2023] Open
Abstract
Acute dislocations of the sternoclavicular joint are uncommon injuries, and it is difficult for physicians to develop expertise in treating these injuries because of their infrequent nature. No level I evidence currently exists for these injuries, but several retrospective studies and surgical techniques have been described. For acute injuries, current recommendations include early treatment with closed reduction. If unable to attain or maintain reduction after a closed attempt, open management should be considered. Previous reviews have outlined relevant anatomy, physical examination findings, and imaging for these injuries. This article aims to review updated information from the past decade regarding techniques for reduction, outcomes, and complications related to the injury and surgical management.
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Affiliation(s)
- William T Obremskey
- From the Division of Orthopaedic Trauma, Vanderbilt University Medical center (Obremskey and Baron), Division of Orthopaedic Trauma, Fundacion Santa Fe de Bogota University Hospital, Bogotá D.C., Colombia (Pesantez); Division of Orthopaedic Trauma, Washington University, St. Louis, MO (Tatman)
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13
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Complications after sternoclavicular surgery. J Shoulder Elbow Surg 2021; 30:e392-e398. [PMID: 33038497 DOI: 10.1016/j.jse.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 09/06/2020] [Accepted: 09/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Sternoclavicular joint (SCJ) pathologies such as instability are rare; therefore, SCJ surgery is performed infrequently. Complications of these surgeries can be devastating. This study evaluated complications, and particularly infections, after SCJ surgery. METHODS A retrospective cohort of 68 patients who underwent SCJ surgery with a minimum follow-up of 1 year was reviewed. Patients' characteristics, intraoperative, and postoperative complications were retrieved. In case of a reoperation, relevant data from the reoperation and microbiological findings were collected. RESULTS Twenty-two men and 46 women with a mean age of 37.5 years (range, 13-70 years) were analyzed. A complication occurred in 26 of 68 patients (38.2%). In 16 patients (23.5%), this was an infection. Cutibacterium acnes was the pathogen in 14 of these infections. Infection occurred more often in men than in women (P = .02). A total of 26 reoperations were performed in our cohort: 14 due to clinical signs of infection, 9 due to instability, 1 due to complaints of SCJ osteoarthritis, and 2 due to other causes. CONCLUSION Complications after SCJ surgery occur more often than previously described. C. acnes infections are often seen. When left untreated, these complications can lead to persistent complaints or recurrent instability due to failure of reconstruction. Therefore, it is of utmost importance to identify infections at an early stage, or better, to prevent them. The use of benzoyl peroxide gel preoperatively seems effective in reducing early C. acnes infections in this type of surgery.
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14
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Parker KM, Somerson JS, Warme WJ. Unicortical sternal graft reconstruction for anterior sternoclavicular joint instability. BMJ Case Rep 2021; 14:e237164. [PMID: 33692041 PMCID: PMC7949389 DOI: 10.1136/bcr-2020-237164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 11/04/2022] Open
Abstract
Sternoclavicular joint (SCJ) injury represents 3%-5% of all shoulder girdle injuries, yet can produce significant pain and disability. While conservative management improves symptoms in most cases, surgical intervention may be indicated for patients with symptoms recalcitrant to nonoperative treatment. A wide range of surgical stabilisation techniques is documented in the literature; however, the scarcity of SCJ pathology has hindered development of a 'gold standard'.We present a minimalistic medial clavicle osteoplasty and SCJ reconstruction using semitendinosus autograft anchored with unicortical sternal tunnels in the 54 years old with chronic SCJ instability. This technique can be performed safely, resulting in joint stability and pain reduction, while avoiding risks and complications noted in the literature with other techniques.
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Affiliation(s)
- Kate M Parker
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas, USA
| | - Winston J Warme
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
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15
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Ogawa T, Masuya M, Onishi S, Iwabuchi S, Yoshii Y, Hirano A, Yamazaki M. Positional anterior sternoclavicular joint dislocation in the acceleration phase of throwing: a case report. JSES Int 2020; 4:532-535. [PMID: 32939480 PMCID: PMC7479031 DOI: 10.1016/j.jseint.2020.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Positional anterior sternoclavicular joint (SCJ) dislocation is relatively rare and needs careful treatment. We report our course of treatment and tips for surgery in a case. The patient was a 16-year-old male outfield baseball player. Three years ago, he had 3 recurrent episodes of right shoulder dislocation. During these injuries, there were forward dislocations of the proximal right clavicle edge accompanied by a creaking sound during the throw acceleration period. Thereafter, the anterior dislocation of the SCJ occurred during the acceleration phase of throwing, and the SCJ naturally repositioned on the shoulder resting position. This situation lingered and he often felt shoulder apprehension during throws, so he opted for surgical treatment just 1 month after the first injury. We performed a modified version of the figure-of-8 technique reported by Wang et al, using the ipsilateral palmaris longus (PL) tendon. The bilateral edge of the PL was attached to a Krackow suture and passed through the bone tunnels opened at the proximal clavicle and proximal sternum so that it became a figure of 8 on the anterior of the SCJ. The stability of the SCJ was confirmed after the surgery.
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Affiliation(s)
- Takeshi Ogawa
- Department of Orthopaedic Surgery and Sports Medicine, Mito Clinical Education and Training Center, University of Tsukuba Hospital, Mito Kyodo General Hospital, Mito, Ibaraki, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | | | - Shinzo Onishi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Sho Iwabuchi
- Department of Orthopaedic Surgery and Sports Medicine, Mito Clinical Education and Training Center, University of Tsukuba Hospital, Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Atsushi Hirano
- Department of Orthopaedic Surgery and Sports Medicine, Mito Clinical Education and Training Center, University of Tsukuba Hospital, Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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16
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Feng WL, Cai X, Li SH, Li ZJ, Zhang K, Wang H, Zhang J, Zhu YJ, Feng DX. Balser Plate Stabilization for Traumatic Sternoclavicular Instabilities or Medial Clavicle Fractures: A Case Series and Literature Review. Orthop Surg 2020; 12:1627-1634. [PMID: 32893491 PMCID: PMC7767773 DOI: 10.1111/os.12726] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 02/01/2023] Open
Abstract
Objective This study was performed to observe the effect of internal Balser plate fixation for treating unstable sternoclavicular joints (SCJ) and displaced medial clavicle fractures. Methods From April 2009 to September 2016, 17 consecutive patients who underwent open reduction and internal Balser plate fixation for SCJ dislocations or medial clavicle fractures were retrospectively reviewed. There were 11 male and six female patients, with a mean age of 45.6 ± 15.5 years. Standardized treatment procedures consisted of reduction, creating a space posterior dorsal osteal face of the sternal manubrium, an inverted Balser plating, and postoperative immobilization. At follow‐up, plain radiographs were assessed for fracture union, implant loosening, degenerative changes, and joint congruity. Clinical evaluation included: completion of the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire; determination of the Constant and Murley score and visual analog scale (VAS) score; and assessment of intraoperative and postoperative complications. Results All patients were followed up, at a mean follow‐up of 20.1 ± 7.9 months, each fracture had a solid union, and each dislocation showed no sign of recurrent dislocation. The mean shoulder forward flexion was 162.9° ± 8.1°. The mean DASH score was 5.2 ± 5.2 points. The mean Constant and Murley joint function score was 93.7 ± 7.9 points, with 15 excellent cases and two good cases. The mean VAS score was 1.1 ± 1.4 points, showing significant improvement compared with the VAS score preoperatively. Postoperative complications included one wound hematoma which was healed after a debridement and one recurrent instability due to hook migration, which underwent revision reconstruction. All patients were satisfied with their treatment outcome at the final follow‐up. Conclusion Sternoclavicular joints dislocation or medial clavicle fractures can be treated successfully with Balser plate fixation. This technique permits early functional exercise while preserving the SCJ.
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Affiliation(s)
- Wei-Lou Feng
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, China
| | - Xiao Cai
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, China
| | - Shu-Hao Li
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, China
| | - Zi-Jun Li
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, China
| | - Kun Zhang
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, China
| | - Hao Wang
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, China
| | - Jun Zhang
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, China
| | - Yang-Jun Zhu
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, China
| | - Dong-Xu Feng
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, China
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17
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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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18
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Tashjian RZ, Ross H, Granger E, Chalmers PN. Single loop allograft reconstruction for sternoclavicular joint instability. JSES Int 2020; 4:719-723. [PMID: 33345205 PMCID: PMC7738445 DOI: 10.1016/j.jseint.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Background Various surgical strategies have been used for the treatment of sternoclavicular joint instability with variable results. The purpose of this study was to report the clinical results of patients who underwent single-loop allograft reconstruction for sternoclavicular joint instability. Methods A total of 10 patients underwent single-loop allograft reconstruction for sternoclavicular joint instability from June 2012 to August 2014 by a single surgeon. All patients had a history of instability of the sternoclavicular joint with persistent chronic subluxation of the joint, magnetic resonance imaging disruption of the sternoclavicular ligaments, and persistent symptoms of pain and instability. Regarding the surgical technique, a single 5.5 mm drill hole was placed in the sternum and a second was placed in the medial aspect of the clavicle. A semitendinosus hamstring allograft was looped between the 2 holes and then tied in a square knot anteriorly. A #5 high-strength suture was used as cerclage as well. Nine of 10 patients (90% follow-up) were available at an average of 3.3 ± 0.84 years postoperatively. The average age of patients at the time of surgery was 42 years (range, 20-73 years). Patients were evaluated postoperatively with outcome scores (visual analog scale pain, American Shoulder and Elbow Surgeons, Simple Shoulder Test), a question regarding tenderness at the sternoclavicular joint, and a question regarding residual instability and overall patient satisfaction (yes/no). Results The average functional outcome scores for the Simple Shoulder Test, visual analog scale pain, and American Shoulder and Elbow Surgeons score were 11.8, 0.9, and 94.8, respectively. Three of 9 patients reported some residual tenderness located to the sternoclavicular joint. No patients reported any residual instability of the sternoclavicular joint. Eight of 9 patients reported that they were satisfied with the procedure. No patients required reoperation, and there were no complications. Conclusion Single-loop allograft reconstruction of the sternoclavicular joint provides reliable pain relief, functional improvement, and joint stability for patients with chronic sternoclavicular joint instability. The simplicity of the procedure eliminates the need for small, multiple drill holes that may lead to fracture between tunnels or the use of a small, thin graft.
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Affiliation(s)
- Robert Z Tashjian
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Hunter Ross
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Erin Granger
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Peter N Chalmers
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
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19
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Lacheta L, Dekker TJ, Goldenberg BT, Horan MP, Rosenberg SI, Pogorzelski J, Millett PJ. Minimum 5-Year Clinical Outcomes, Survivorship, and Return to Sports After Hamstring Tendon Autograft Reconstruction for Sternoclavicular Joint Instability. Am J Sports Med 2020; 48:939-946. [PMID: 32040343 DOI: 10.1177/0363546519900896] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Instability of the sternoclavicular (SC) joint is a rare but potentially devastating pathologic condition, particularly when it occurs in young or active patients, where it can lead to persistent pain and impairment of shoulder function. SC joint reconstruction using a hamstring tendon autograft is a commonly used treatment option, but midterm results are still lacking. PURPOSE/HYPOTHESIS The purpose of this study was to assess the clinical outcomes, survivorship, and return-to-sports rate after SC joint reconstruction using a hamstring tendon autograft in patients suffering from SC joint instability. We hypothesized that SC joint reconstruction would result in good clinical outcomes, high rate of survivorship, and a high rate of return to sports. STUDY DESIGN Case series; Level of evidence, 4. METHODS All patients who underwent SC joint reconstruction with a hamstring tendon autograft for SC joint instability, with a minimum 5-year follow-up, were included. Patient-reported outcomes were assessed prospectively by the use of the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numerical Evaluation (SANE) score, short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, 12-Item Short Form Health Survey (SF-12) physical component summary (PCS), and patient satisfaction. Survivorship of reconstruction was defined as no further revision surgery or clinical failure such as recurrent instability or subluxation events. Return to sports and pain were assessed using a customized questionnaire. RESULTS A total of 22 shoulders that underwent SC joint reconstruction, with a mean patient age of 31.3 years (range, 15.8-57.0 years) at the time of surgery, were included. At the final evaluation, 18 shoulders, with a mean follow-up of 6.0 years (range, 5.0-7.3 years), completed a minimum 5-year follow-up. All clinical outcome scores improved significantly from preoperatively to postoperatively: ASES (50.0 to 91.0; P = .005), SANE (45.9 to 86.0; P = .007), QuickDASH (44.2 to 12.1; P = .003), and SF-12 PCS (39.4 to 50.9; P = .001). Median postoperative satisfaction was 9 (range, 7-10). The construct survivorship was 90% at 5-year follow-up. There were 2 patients with failed treatment at 82 and 336 days postoperatively because of instability or pain who underwent revision SC joint reconstruction and capsulorrhaphy. Another patient had a superficial wound infection, which was debrided once and resulted in a good clinical outcome. Of the patients who answered optional sports activity questions, 15 (17 shoulders, 77%) participated in recreational or professional sports before the injury. At final follow-up, 14 patients (16 of 17 shoulders, 94%) returned to their preinjury level of sports. The visual analog scale score for pain today (P = .004) and pain at its worst (P = .004) improved significantly from preoperatively to postoperatively. CONCLUSION SC joint reconstruction with a hamstring tendon autograft for SC joint instability resulted in significantly improved clinical outcomes with high patient satisfaction and 90% survivorship at midterm follow-up. Furthermore, 94% of this young and high-demand patient population returned to their previous level of sports. Concerns in terms of advanced postinstability arthritis were not confirmed because a significant decrease in pain was found after a minimum 5-year follow-up.
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Affiliation(s)
- Lucca Lacheta
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, USA.,Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Travis J Dekker
- Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany.,The Steadman Clinic, Vail, Colorado, USA
| | - Brandon T Goldenberg
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Marilee P Horan
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Samuel I Rosenberg
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Jonas Pogorzelski
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Peter J Millett
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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20
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Bakir MS, Unterkofler J, Hönning A, Haralambiev L, Kim S, Ekkernkamp A, Schulz-Drost S. Shoulder girdle injuries involving the medial clavicle differ from lateral clavicle injuries with a focus on concomitant injuries and management strategies: A retrospective study based on nationwide routine data. PLoS One 2019; 14:e0224370. [PMID: 31652299 PMCID: PMC6814233 DOI: 10.1371/journal.pone.0224370] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/13/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction Although shoulder girdle injuries are frequent, those of the medial part are widely unexplored. Our aim is to improve the knowledge of this rare injury and its management in Germany by big data analysis. Methods The data are based on ICD-10 codes of all German hospitals as provided by the German Federal Statistical Office. Based on the ICD-10 codes S42.01 (medial clavicle fracture, MCF) and S43.2 (sternoclavicular joint dislocation, SCJD), anonymized patient data from 2012 to 2014 were evaluated retrospectively for epidemiologic issues. We analyzed especially the concomitant injuries and therapy strategies. Results A total of 114,003 cases with a clavicle involving shoulder girdle injury were identified with 12.5% of medial clavicle injuries (MCI). These were accompanied by concomitant injuries, most of which were thoracic and craniocerebral injuries as well as injuries at the shoulder/upper arm. A significant difference between MCF and SCJD concerning concomitant injuries only appears for head injuries (p = 0.003). If MCI is the main diagnosis, soft tissue injuries typically occur as secondary diagnoses. The MCI are significantly more often associated with concomitant injuries (p < 0.001) for almost each anatomic region compared with lateral clavicle injuries (LCI). The main differences were found for thoracic and upper extremity injuries. Different treatment strategies were used, most frequently plate osteosynthesis in more than 50% of MCF cases. Surgery on SCJD was performed with K-wires, tension flange or absorbable materials, fewer by plate osteosynthesis. Conclusions We proved that MCI are rare injuries, which might be why they are treated by inhomogeneous treatment strategies. No standard procedure has yet been established. MCI can occur in cases of severely injured patients, often associated with severe thoracic or other concomitant injuries. Therefore, MCI appear to be more complex than LCI. Further studies are required regarding the development of standard treatment strategy and representative clinical studies.
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Affiliation(s)
- M. Sinan Bakir
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
- * E-mail:
| | - Jan Unterkofler
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
- Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Alexander Hönning
- Center of Clinical Science, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Lyubomir Haralambiev
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Simon Kim
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Axel Ekkernkamp
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Stefan Schulz-Drost
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Erlangen, Bayern, Germany
- Department of Trauma, Orthopedic and Hand Surgery, Helios Hospital Schwerin, Schwerin, Mecklenburg-Vorpommern, Germany
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21
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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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22
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Wu G, Chen S, Lin S, Wang W. [Treatment of traumatic anterior dislocation of sternoclavicular joint with allogeneic tendon of "W" type knit]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:976-980. [PMID: 31407556 PMCID: PMC8337905 DOI: 10.7507/1002-1892.201902008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/18/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate effectiveness of allogeneic tendon of "W" type knit in repair of traumatic anterior dislocation of sternoclavicular joint. METHODS Between June 2013 and June 2017, 12 patients with traumatic anterior dislocation of sternoclavicular joint after poor conservative treatment were treated with allogeneic tendon of "W" type knit. Of them, 10 were males and 2 were females, aged from 25 to 58 years (mean, 42 years). All injuries were caused by traffic accidents. The time from injury to operation was 4-12 weeks (median, 6 weeks). All of them were closed injuries. The patients had no fracture around the shoulder, or blood vessels, nerves, and other adjacent limb joint injuries. The operation time, intraoperative blood loss, incision healing, and complications were recorded. The sternoclavicular joint was observed by X-ray film and CT at 1 year after operation. Visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, Rockwood score, modified Hospital for Special Surgery (HSS) score, and Constant-Murley score were used to evaluate the function of shoulder joint after operation. RESULTS The operation time was 60-80 minutes (mean, 70 minutes). The intraoperative blood loss was 50-100 mL (mean, 60 mL). Primary healing of incision was obtained in all patients without complications. All the patients were followed up 12-24 months (mean, 18 months). At 1 year after operation, X-ray film and CT examination showed that the position of sternoclavicular joint was satisfactory. At 1 year after operation, the Rockwood score was 12-14 (mean, 13). The UCLA score was 28-34 (mean, 31). The VAS score was significant lower than that before operation ( P<0.05), and the Constant-Murley score and modified HSS score were significantly higher than those before operation ( P<0.05). CONCLUSION The repair of traumatic anterior dislocationr of sternoclavicula joint with allogeneic tendon of "W" type knit can effectively reconstruct the stability of the joint, retain the physiological fretting, and obtain satisfactory results.
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Affiliation(s)
- Guozhong Wu
- Department of Orthopedics, the Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000, P.R.China
| | - Shoubo Chen
- Department of Orthopedics, the Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000, P.R.China
| | - Sanfu Lin
- Department of Orthopedics, the Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000, P.R.China
| | - Wenhuai Wang
- Department of Orthopedics, the Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000,
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23
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Peebles LA, Aman ZS, Preuss FR, Samuelsen BT, Zajac TJ, Patel RB, Provencher MT. Chronic Instability and Pain of the Sternoclavicular Joint: Treatment With Semitendinosus Allograft to Restore Joint Stability. Arthrosc Tech 2019; 8:e629-e635. [PMID: 31334021 PMCID: PMC6624162 DOI: 10.1016/j.eats.2019.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/16/2019] [Indexed: 02/03/2023] Open
Abstract
Chronic instability of the sternoclavicular (SC) joint is a challenging clinical problem, particularly in a patient population for which nonoperative forms of treatment prove ineffective. Patients present after experiencing recurrent subluxation events and subsequent pain, which commonly result in increasing functional limitation. Recurrent SC joint instability of this nature can lead to damage of the SC joint cartilage and bone, and in cases of posterior subluxation or dislocation, damage to mediastinal structures. While the precise treatment algorithm requires tailoring to individual patients and their respective pathologies, we have demonstrated successful outcomes in correcting chronic SC joint instability by means of SC joint reconstruction with semitendinosus allograft, SC joint capsular reconstruction, and, in cases of arthritic damage, resection of a small portion of the degenerative component of the medial clavicle. The purpose of this Technical Note is to describe a technique that uses a semitendinosus allograft to stabilize the SC joint combined with a capsular reconstruction in patients who have previously failed nonoperative treatment methods.
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Affiliation(s)
- Liam A Peebles
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Zachary S Aman
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Fletcher R Preuss
- University of Virginia School of Medicine, Charlottesville, Virginia, U.S.A
| | | | | | - Ravi B Patel
- Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, Michigan, U.S.A
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,Steadman Clinic, Vail, Colorado, U.S.A
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24
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Martetschläger F, Reifenschneider F, Fischer N, Wijdicks CA, Millett PJ, Imhoff AB, Braun S. Sternoclavicular Joint Reconstruction Fracture Risk Is Reduced With Straight Drill Tunnels and Optimized With Tendon Graft Suture Augmentation. Orthop J Sports Med 2019; 7:2325967119838265. [PMID: 31041330 PMCID: PMC6481000 DOI: 10.1177/2325967119838265] [Citation(s) in RCA: 10] [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: 01/29/2023] Open
Abstract
Background: Despite the rare entity of sternoclavicular joint (SCJ) instability, a variety of different reconstruction techniques for SCJ dislocations have been described. A technique with oblique drilling has been proposed to reduce intraoperative risks. Purpose: To biomechanically investigate different cerclage reconstruction techniques and the benefit of additional reinforcement using suture tape. Study Design: Controlled laboratory study. Methods: Reconstructed artificial bone specimens were mounted on a mechanical testing machine. They were subjected to anterior and posterior translation, analyzing ultimate strength, displacement, stiffness, and elongation. For stage 1, different angulations of the drill tunnels through the sternum and clavicle were compared. Straight drill tunnels from anterior to posterior were compared with 45° oblique drill tunnels. For stage 2, three different materials for cerclage reconstruction were compared: (1) suture tape alone (FT group), (2) tendon graft alone (tendon group), and (3) tendon graft with suture tape augmentation (tendon+FT group). Results: For the FT group, in the anterior and posterior directions, straight drill holes resulted in a significantly higher load to failure (936.9 ± 122.5 N) compared with oblique ones (434.5 ± 20.2 N) (P < .0001). During cyclic testing, all specimens with straight drill holes survived the 5- to 550-N step, while all specimens with oblique ones failed during the 5- to 450-N step. Analyzing the graft material choice, the mean load to failure was 556.6 ± 174.3 N for the tendon group, 936.9 ± 122.5 N for the FT group, and 767.0 ± 110.7 N for the tendon+FT group (P = .089). The stiffness of the tendon+FT group was significantly lower than that of the FT group and significantly higher than that of the tendon group. Conclusion: Oblique tunnel placement during SCJ reconstruction, while reducing the intraoperative risk, results in decreased primary stability of the construct. Tendon graft reconstruction with suture tape augmentation leads to enhanced stability and optimizes biomechanical properties of the construct. Clinical Relevance: The surgical technique with straight drill holes has superior initial biomechanical properties and may likewise produce superior clinical outcomes in the treatment of SCJ instability. Suture tape augmentation can provide additional stability to reconstruction procedures.
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Affiliation(s)
- Frank Martetschläger
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany
| | | | - Nicole Fischer
- Department of Research & Development, Arthrex GmbH, Munich, Germany
| | - Coen A Wijdicks
- Department of Research & Development, Arthrex GmbH, Munich, Germany
| | | | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sepp Braun
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Gelenkpunkt, Sport- und Gelenkchirurgie Innsbruck, Innsbruck, Austria
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25
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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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Widodo W, Fahrudhin M, Kamal AF. Joint reconstruction using sternocleidomastoid tendon autograft as a treatment for traumatic posterior dislocation of sternoclavicular joint: A case report. Trauma Case Rep 2018; 18:8-16. [PMID: 30511006 PMCID: PMC6258128 DOI: 10.1016/j.tcr.2018.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction Posterior sternoclavicular joint dislocations are extremely rare and emergent injuries. Presentation of case We presented a case of a seventeen-year-old male patient who was diagnosed with traumatic posterior dislocation. He underwent joint reconstruction using sternocleidomastoid tendon autograft, and the operation went well. Discussion At four-week and fourteen-week follow-up post-operatively revealed a surgical wound that healed well, regained stable sternoclavicular joint that was marked by a normal left sternoclavicular notch, full range of movement of the left shoulder and the pain subsided. Conclusion These findings provide evidence that the method of joint reconstruction and augmentation may produce good outcome for posterior dislocation of the sternoclavicular joint.
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Affiliation(s)
- Wahyu Widodo
- Department of Orthopaedic & Traumatology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - MuhTrinugroho Fahrudhin
- Department of Orthopaedic & Traumatology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Achmad Fauzi Kamal
- Department of Orthopaedic & Traumatology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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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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Ao R, Zhu Y, Zhou J, Jian Z, Shi J, Li C, Hu W, Yu B. Locking plate for treating traumatic sternoclavicular joint dislocation: a case series. BMC Musculoskelet Disord 2018; 19:7. [PMID: 29316904 PMCID: PMC5759215 DOI: 10.1186/s12891-017-1903-8] [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] [Received: 06/22/2017] [Accepted: 12/11/2017] [Indexed: 03/04/2023] Open
Abstract
Background Traumatic sternoclavicular joint dislocations are rare; closed reduction is the primary treatment. The failure of closed reduction or a prominent insult to the skin may require surgery to ensure the best possible outcome. Methods The records of 5 patients operated at our institution for sternoclavicular joint dislocation were reviewed. All patients were treated with open reduction and single 3.5-mm locking plate was used for fixation. Outcomes were evaluated with the Constant Shoulder Score (CSS) and Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. Intraoperative and postoperative complications were recorded. Results All the patients had an average follow-up of 14 months (range, 11–16 months). At the final follow-up, the mean CSS score was 89.5 (range, 78–98) and the mean DASH score was 9.0 (range, 4–16). There were no early complications, including wound infection or neurologic or vascular deficits; there were also no broken or loosened screws or plates. No case of redislocation or arthrosis was observed. Conclusion Our study indicates that open reduction and fixation with a single locking plate for the treatment of traumatic sternoclavicular joint dislocation is a safe, relatively simple surgical procedure that can lead to satisfactory outcomes.
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Affiliation(s)
- Rongguang Ao
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Huinan Town, Pudong, Shanghai, 201399, People's Republic of China
| | - Yalong Zhu
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Huinan Town, Pudong, Shanghai, 201399, People's Republic of China
| | - Jianhua Zhou
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Huinan Town, Pudong, Shanghai, 201399, People's Republic of China
| | - Zhen Jian
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Huinan Town, Pudong, Shanghai, 201399, People's Republic of China
| | - Jifei Shi
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Huinan Town, Pudong, Shanghai, 201399, People's Republic of China
| | - Cheng Li
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Huinan Town, Pudong, Shanghai, 201399, People's Republic of China
| | - Wankun Hu
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Huinan Town, Pudong, Shanghai, 201399, People's Republic of China
| | - Baoqing Yu
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Huinan Town, Pudong, Shanghai, 201399, People's Republic of China.
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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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Schmitt S, Magosch P, Habermeyer P, Lichtenberg S. [Chronic acromioclavicular joint injury of Rockwood V type with concomitant chronic anterior sternoclavicular instability]. Unfallchirurg 2017; 120:795-803. [PMID: 28741077 DOI: 10.1007/s00113-017-0384-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Bipolar dislocation of the clavicle is rare. In the literature, every reported bipolar dislocation of the clavicle is caused by a traumatic injury with loss of function of the affected shoulder. Currently, there is no recommendation to treat. A conservative treatment can be tried first to achieve adequate shoulder function. If this cannot be achieved, surgical treatment will be indicated. In the literature, many options for surgical treatment are described. This article presents a case of a chronic Rockwood V injury with chronic anterior sternoclavicular joint instability. The special feature of this case was the arthroscopically assisted stabilization of the acromioclavicular joint (ACJ) with the ipsilateral semitendinosus tendon graft and the open stabilization of the sternoclavicular joint (SCJ) with the ipsilateral gracilis tendon graft. A lateral fracture of the clavicle in the course of the postoperative treatment was treated with a plate osteosynthesis. At follow-up after six months, the postoperative shoulder function was restored. The ACJ and the SCJ were stable in clinical and radiographic examination. This case report shows the first surgical treatment using two tendon grafts for combined stabilization of the ACJ and SCJ.
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Affiliation(s)
- Sebastian Schmitt
- Schulter- und Ellenbogenchirurgie, Deutsches Gelenkzentrum Heidelberg, ATOS Klinik Heidelberg, Bismarckstraße 9-15, 69115, Heidelberg, Deutschland.
| | - Petra Magosch
- Schulter- und Ellenbogenchirurgie, Deutsches Gelenkzentrum Heidelberg, ATOS Klinik Heidelberg, Bismarckstraße 9-15, 69115, Heidelberg, Deutschland
| | - Peter Habermeyer
- Schulter- und Ellenbogenchirurgie, Deutsches Gelenkzentrum Heidelberg, ATOS Klinik Heidelberg, Bismarckstraße 9-15, 69115, Heidelberg, Deutschland
| | - Sven Lichtenberg
- Schulter- und Ellenbogenchirurgie, Deutsches Gelenkzentrum Heidelberg, ATOS Klinik Heidelberg, Bismarckstraße 9-15, 69115, Heidelberg, Deutschland
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31
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Zhang C, Lin L, Liang J, Wang B, Chen G, Chen H. Efficacy analysis of a novel sternoclavicular hook plate for treatment of unstable sternoclavicular joint dislocation or fracture. J Orthop Surg (Hong Kong) 2017; 25:2309499016684488. [PMID: 28211287 DOI: 10.1177/2309499016684488] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Sternoclavicular joint is an amphiarthrodial joint formed by the clavicle and sternal manubrium. This joint becomes chronically unstable in case of a medial clavicle dislocation or fracture, and improper treatment could cause malformation and pain. We aimed to determine the efficacy of a novel sternoclavicular hook plate for treatment of unstable sternoclavicular joint dislocation or fracture. METHODS Between June 2011 and December 2013, the sternoclavicular hook plate was used to surgically treat 32 adult patients with unstable sternoclavicular joint dislocation or fracture. Of these, 12 and 5 patients suffered from anterior and posterior dislocation of the sternoclavicular joint, respectively, 10 had medial clavicle fracture, and 5 had fracture dislocation. For anterior fracture dislocation, the standard sternoclavicular hook plate was used, while for the posterior dislocation, screws were added at the distal end of the hook plate, anterior to the sternal manubrium, to prevent postoperative redislocation. RESULTS No intraoperative complications were observed during the procedure. Postoperative X-ray and computed tomography revealed normal anatomical positions of sternoclavicular joints and excellent positions of internal fixation. About 3-6 months after surgery, all patients achieved primary healing without redislocation of the sternoclavicular joint along with satisfactory restoration of anatomical structures of the medial clavicle; nine patients had swelling but no pain around the sternoclavicular joints. Internal fixation was removed in 29 patients 6-12 months postoperatively and no sequelae were observed. CONCLUSION This novel sternoclavicular hook plate demonstrated excellent efficacy and could provide a reliable therapeutic approach for this kind of trauma.
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Affiliation(s)
- Chuanyi Zhang
- Taizhou Hospital of Zhejiang Province, Linhai, Zhejiang, China
| | - Lie Lin
- Taizhou Hospital of Zhejiang Province, Linhai, Zhejiang, China
| | - Junbo Liang
- Taizhou Hospital of Zhejiang Province, Linhai, Zhejiang, China
| | - Bin Wang
- Taizhou Hospital of Zhejiang Province, Linhai, Zhejiang, China
| | - Guofu Chen
- Taizhou Hospital of Zhejiang Province, Linhai, Zhejiang, China
| | - Haixiao Chen
- Taizhou Hospital of Zhejiang Province, Linhai, Zhejiang, China
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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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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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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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Hwang WJ, Lee Y, Yoon YS, Kim YJ, Ryu HY. Surgical Treatment of Sternoclavicular Joint Dislocation Using a T-plate. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 49:221-3. [PMID: 27298805 PMCID: PMC4900870 DOI: 10.5090/kjtcs.2016.49.3.221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/15/2015] [Accepted: 10/15/2015] [Indexed: 12/01/2022]
Abstract
A 22-year-old man was hospitalized with a sternoclavicular joint (SCJ) dislocation caused by a traffic accident. Surgical reduction and fixation of the SCJ were performed using a T-plate. SCJ dislocation is rare, accounting for less than 1% of all dislocations, and is usually treated conservatively, although severe cases may require surgery. Surgery typically involves joint reduction and fixation using an autologous tendon graft, but this has disadvantages such as the requirement for additional surgery to obtain autologous tissue and an extended operative time. To overcome these issues, here, we performed a simple SCJ reduction and fixation using a T-plate and achieved good results.
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Affiliation(s)
- Wan Jin Hwang
- Department of Thoracic and Cardiovascular Surgery, Konyang University College of Medicine
| | - Yeiwon Lee
- Department of Thoracic and Cardiovascular Surgery, Konyang University College of Medicine
| | - Yoo Sang Yoon
- Department of Thoracic and Cardiovascular Surgery, Konyang University College of Medicine
| | - Young Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Konyang University College of Medicine
| | - Han Young Ryu
- Department of Thoracic and Cardiovascular Surgery, Konyang University College of Medicine
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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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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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Management and functional outcomes following sternoclavicular joint dislocation. Injury 2015; 46:1906-13. [PMID: 26169233 DOI: 10.1016/j.injury.2015.05.050] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/14/2015] [Accepted: 05/31/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study is to describe the demographics, management and functional outcomes of patients presenting with a sternoclavicular joint (SCJ) dislocation. METHODS A retrospective medical record review was conducted examining patients with SCJ dislocation admitted to an adult level 1 trauma centre between 2004 and 2012. Patient demographics, symptoms, associated injuries, imaging technique used in diagnosis, surgical data and neurovascular complications were recorded. Patients received a single-page questionnaire to assess physical function using two validated shoulder questionnaires. RESULTS A total of 22 patients were identified, out of which 77% sustained a posterior dislocation. Mean age was 30 years (range 16-65), and the most common cause of injury was a direct blow during sport (n=11). Open reduction and internal fixation were performed in 13 patients, definitive closed reduction used in seven and two patients were managed expectantly. Functional outcomes for patients were excellent, with American Shoulder and Elbow Society (ASES) and Subjective Shoulder Value (SSV) scores >80 in 87.5% of cases. There were preoperative symptoms consistent with mediastinal compression in 50% and one delayed presentation with thoracic outlet syndrome. No patient had neurovascular compromise or functional deficit post-operatively, regardless of joint congruency. CONCLUSION This is the largest case series from a single institution currently available examining SCJ dislocation. We recommend an initial trial of closed reduction, followed by open reduction and internal fixation if there is joint instability or malreduction. Functional outcome following both closed and open reduction of the SCJ is excellent.
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Yang JS, Bogunovic L, Brophy RH, Wright RW, Scott R, Matava M. A Case of Posterior Sternoclavicular Dislocation in a Professional American Football Player. Sports Health 2015; 7:318-25. [PMID: 26137177 PMCID: PMC4481669 DOI: 10.1177/1941738113502153] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Sternoclavicular (SC) dislocation is a rare injury of the upper extremity. Treatment of posterior SC dislocation ranges from conservative (closed reduction) to operative (open reduction with or without surgical reconstruction of the SC joint). To date, we are unaware of any literature that exists pertaining to this injury or its treatment in elite athletes. The purpose of this case report is to describe a posterior SC joint dislocation in a professional American football player and to illustrate the issues associated with its diagnosis and treatment and the athlete’s return to sports. To our knowledge, this case is the first reported in a professional athlete. He was treated successfully with closed reduction and returned to play within 5 weeks of injury.
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Affiliation(s)
- Justin S Yang
- Department of Orthopedics, Washington University, St Louis, Missouri
| | | | - Robert H Brophy
- Department of Orthopedics, Washington University, St Louis, Missouri
| | - Rick W Wright
- Department of Orthopedics, Washington University, St Louis, Missouri
| | | | - Matthew Matava
- Department of Orthopedics, Washington University, St Louis, Missouri
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Sabatini JB, Shung JR, Clay TB, Oladeji LO, Minnich DJ, Ponce BA. Outcomes of augmented allograft figure-of-eight sternoclavicular joint reconstruction. J Shoulder Elbow Surg 2015; 24:902-7. [PMID: 25487906 DOI: 10.1016/j.jse.2014.10.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/03/2014] [Accepted: 10/05/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Sternoclavicular joint (SCJ) instability is a rare condition resulting in impaired function and shoulder girdle pain. Various methods for stabilizing the SCJ have been proposed, with biomechanical analysis demonstrating superior stiffness and peak load properties with a figure-of-8 tendon graft technique. The purpose of this study was to evaluate the clinical outcomes of SCJ reconstruction with an interference screw figure-of-8 allograft tendon technique. METHODS A retrospective analysis of a consecutive cohort of patients from 2007 to 2011 was performed for all patients undergoing SCJ reconstruction for instability. All patients were treated for SCJ instability with a figure-of-8 allograft reconstruction augmented by 2 tenodesis screws. Outcomes were performed with the American Shoulder and Elbow Surgeons (ASES) score, the shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and the visual analog scale (VAS) for pain score for all patients. Intraoperative and postoperative complications were recorded. RESULTS A total of 10 patients were included in the study, with an average follow-up of 38 months (range, 11.6-66.8 months). Preoperatively, the mean ASES score was 35.3 points (range, 21.7-55 points), whereas the postoperative mean ASES score increased to 84.7 points (range, 66.6-95 points). The mean VAS score improved from 7.0 (range, 5-10) before surgery to 1.15 (range, 0-3) at follow-up, and the QuickDASH score average was 17.0 points (range, 0 to 38.6 points). Minor postoperative complications were noted in 2 patients. CONCLUSION Patients who underwent repair of SCJ instability by an augmented figure-of-8 allograft tendon reconstruction report marked improvements in both shoulder function and pain relief.
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Affiliation(s)
- Jefferson B Sabatini
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joseph R Shung
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - T Bradly Clay
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Lasun O Oladeji
- University of Illinois College of Medicine at Peoria (UICOMP), Peoria, IL, USA
| | - Douglas J Minnich
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brent A Ponce
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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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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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, Imhoff AB. [Surgical stabilization of acute/chronic sternoclavicular instability with autologous gracilis tendon graft]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2014; 26:218-27. [PMID: 24924502 DOI: 10.1007/s00064-013-0275-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 12/19/2013] [Accepted: 12/19/2013] [Indexed: 11/27/2022]
Abstract
SURGICAL OBJECTIVE Restoration of joint stability and unimpaired, painless shoulder function INDICATIONS Chronic and recurrent painful instabilities of the sternoclavicular (SC) joint. Locked posterior instability. CONTRAINDICATIONS A lack of autologous tendon grafts due to harvesting of all hamstring grafts during prior surgical procedures and general contraindications for surgery/anesthesia. SURGICAL TECHNIQUE Joint stability is restored by a gracilis tendon allograft passed through two drill holes in the sternum and the medial clavicle using a figure-of-eight configuration. POSTOPERATIVE MANAGEMENT Immobilization in a sling for 6 weeks with passive motion exercises followed by 6 weeks of active mobilization without weight-bearing. After 12 weeks, continuous remobilization with increasing weight-bearing. RESULTS SC joint reconstruction using an autologous tendon graft in a figure-of-eight configuration can significantly improve shoulder function and pain relief. However, some impairment of shoulder function or persistent complaints may occur, which must be discussed with the patient in the preoperative setting.
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Affiliation(s)
- F Martetschläger
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland,
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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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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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