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Galina JM, Miller SD, Whelan TJ, Pavlesen S, Ferrick MR. Incidence of Intraoperative Cardiothoracic Intervention During Open Surgery Following Acute Posterior Sternoclavicular Joint Injury: A Case Series and Review of the Literature. J Pediatr Orthop 2024; 44:421-426. [PMID: 38712689 DOI: 10.1097/bpo.0000000000002696] [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] [Indexed: 05/08/2024]
Abstract
BACKGROUND Acute posterior sternoclavicular joint injuries are rare but potentially lethal injuries-signs of mediastinal compression range from nonspecific to neurovascular compromise. Currently, orthopaedic experts recommend a cardiothoracic surgeon be placed on standby during open surgery for potential intraoperative complications. However, few studies have reported on how often cardiothoracic intervention is required. METHODS First, we identified patients in our institution by CPT codes 23530, 23525, and 23532 from January 1, 2002 to May 1, 2023. Demographic variables and intraoperative cardiothoracic intervention rates were collected. Second, we systematically reviewed the literature to identify articles on acute posterior sternoclavicular injury using PubMed, Embase, and CINAHL databases (through August 20, 2023). Exclusion criteria included conservative treatment, successful closed reduction, chronic injury (>6 wk) cadaver studies, reviews, and nonavailable text. RESULTS Thirteen local patients underwent open surgery for an acute posterior sternoclavicular joint injury, 11 males and 2 females with an average age of 18.2 years old (range: 15 to 32.4). The most common mechanism of injury was sports (n=9; 69.2%). Four (30.8%) patients had physical or radiographic evidence of mediastinal compression. No patients required intraoperative cardiothoracic intervention in our institution. The literature search yielded 132 articles and 512 open surgeries for acute posterior sternoclavicular joint injuries. Four patients required intraoperative cardiothoracic intervention, all of whom presented with polytrauma and/or clinical or radiographic signs of neurovascular compromise, giving a combined overall rate of 0.76%. CONCLUSIONS Expert opinion commonly recommends cardiothoracic backup during open surgery for acute posterior sternoclavicular joint injuries. On the basis of our local data and systematic literature review, we found an overall cardiothoracic intervention rate of 0.76%. In the presence of polytrauma and/or findings of neurovascular compromise, we suggest having cardiothoracic surgery on close standby during the procedure. However, a patient with an isolated acute posterior sternoclavicular joint injury and no clinical or radiographic findings of neurovascular compromise does not appear to require a cardiothoracic surgeon on standby. Ultimately, the decision to involve cardiothoracic backup during open surgery for an acute posterior sternoclavicular injury should be made on a case-by-case basis after a thorough physical and radiographic evaluation of the patient. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jesse M Galina
- Department of Orthopaedic Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | | | - Timothy J Whelan
- Department of Orthopaedic Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Sonja Pavlesen
- Department of Orthopaedic Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Michael R Ferrick
- Department of Orthopaedic Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
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The Frequency of Mediastinal Injury in Acute Posterior Sternoclavicular Dislocations: A Multicenter Study. J Pediatr Orthop 2021; 40:e927-e931. [PMID: 32804865 DOI: 10.1097/bpo.0000000000001649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute posterior sternoclavicular dislocations (APSCD) are rare injuries that historically have prompted concern for injury to the great vessels and other mediastinal structures from initial trauma or subsequent treatment, resulting in the recommendation that a thoracic or vascular surgeon be present or available during operative treatment. The objectives of the study were to characterize the demographic, clinical, and radiographic characteristics of a large series of APSCDs in skeletally immature patients and to describe the rate and nature of any vascular or mediastinal complications that occurred during treatment. METHODS Following Institutional Review Board approval, records of consecutive patients under 25 years of age treated for APSCD were collected from each of 6 participating centers. Only acute injuries (sustained fewer than 10 days before presentation) were included. Patient demographics, injury mechanism, associated mediastinal injuries, and need for thoracic/vascular surgery were recorded. Mediastinal structures injured or compressed by mass effect were specifically characterized by review of preoperative computed tomography imaging. RESULTS Review identified 125 patients with a mean age of 14.7 years; 88% were male. APSCD most commonly resulted from a sporting injury (74%) followed by falls from standing height (10%) and high-energy motor vehicle trauma (10%). The most common finding on cross-sectional imaging was compression without laceration of the ipsilateral brachiocephalic vein (50%). Eleven patients had successful closed reduction, and 114 (90%) had open reduction and internal fixation, with 25 failed or unstable closed reductions preceding open treatment. There were no vascular or mediastinal injuries during reduction or fixation that required intervention. CONCLUSIONS In this multicenter series of 125 APSCDs no injuries to the great vessels/mediastinal structures requiring intervention were identified. Although more than half of patients had evidence of extrinsic vascular compression at the time of injury, careful open reduction of acute injuries can be safely performed. Although vascular injuries following APSCD seem to be quite rare, vascular complications can be catastrophic. Treating providers should consider these data and their own institutional resources to maximize patient safety during the treatment of APSCD. LEVEL OF EVIDENCE Level III-therapeutic case control study.
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Kraus R, Zwingmann J, Jablonski M, Bakir MS. Dislocations of the acromioclavicular and sternoclavicular joint in children and adolescents: A retrospective clinical study and big data analysis of routine data. PLoS One 2020; 15:e0244209. [PMID: 33370356 PMCID: PMC7769445 DOI: 10.1371/journal.pone.0244209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/04/2020] [Indexed: 12/13/2022] Open
Abstract
Background Dislocations of the sternoclavicular joint (anterior/posterior) and acromioclavicular joint (SCJ and ACJ, respectively) are rare injuries in childhood/adolescence, each having its own special characteristics. In posterior SCJ dislocation, the concomitant injuries in the upper mediastinum are most important complication, while in anterior SCJ dislocation there is a risk of permanent or recurrent instability. Methods In a retrospective analysis from seven pediatric trauma centers under the leadership of the Section of Pediatric Traumatology of the German Trauma Society, children (<18 years) were analyzed with focus on age, gender, trauma mechanism, diagnostics, treatment strategy and follow-up results. Additional epidemiological big data analysis from routine data was done. Results In total 24 cases with an average age of 14.4 years (23 boys, 1 girl) could be evaluated (7x ACJ dislocation type ≥ Rockwood III; 17x SCJ dislocation type Allman III, including 12 posterior). All ACJ dislocations were treated surgically. Postoperative immobilization lasted 3–6 weeks, after which a movement limit of 90 degrees was recommended until implant removal. Patients with SCJ dislocation were posterior dislocations in 75%, and 15 of 17 were treated surgically. One patient had a tendency toward sub-dislocation and another had a relapse. Conservatively treated injuries healed without complications. Compared to adults, SCJ injuries were equally rarely found in children (< 1% of clavicle-associated injuries), while pediatric ACJ dislocations were significantly less frequent (p<0.001). Conclusions In cases of SCJ dislocations, our cohort analysis confirmed both the heterogeneous spectrum of the treatment strategies in addition to the problems/complications based on previous literature. The indication for the operative or conservative approach and for the specific method is not standardized. In order to be able to create evidence-based standards, a prospective, multicenter-study with a sufficiently long follow-up time would be necessary due to the rarity of these injuries in children. The rarity was emphasized by our routine data analysis.
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Affiliation(s)
- Ralf Kraus
- Department of Trauma Surgery and Orthopedics, Klinikum Bad Hersfeld GmbH, Bad Hersfeld, Germany
- Section of Pediatric Traumatology (Sektion Kindertraumatologie, SKT) of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie, DGU), Berlin, Germany
- * E-mail: (RK); (MSB)
| | - Joern Zwingmann
- Section of Pediatric Traumatology (Sektion Kindertraumatologie, SKT) of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie, DGU), Berlin, Germany
- Department of Trauma Surgery and Orthopedics, St. Elisabethen Klinikum, Ravensburg, Germany
| | - Manfred Jablonski
- Section of Pediatric Traumatology (Sektion Kindertraumatologie, SKT) of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie, DGU), Berlin, Germany
- Department of Pediatric Surgery and Urology, Kinderkrankenhaus Auf der Bult, Hannover, Germany
| | - M. Sinan Bakir
- Section of Pediatric Traumatology (Sektion Kindertraumatologie, SKT) of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie, DGU), Berlin, Germany
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Greifswald, Germany
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
- * E-mail: (RK); (MSB)
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Iwai T, Tanaka K, Okubo M. Closed reduction of a posterior sternoclavicular joint dislocation: A case report. Trauma Case Rep 2018; 17:1-4. [PMID: 30310838 PMCID: PMC6178144 DOI: 10.1016/j.tcr.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2018] [Indexed: 11/29/2022] Open
Abstract
Sternoclavicular joint dislocation (SCJD) is a rare injury; there are only two reported cases of SCJD that have occurred during judo practice. We present a case of an 18-year-old male athlete who fell while practicing judo and experienced upper left chest pain. He was diagnosed with posterior SCJD at another institute before being transferred to our hospital. Closed reduction was initially not possible using traditional methods. Reduction was eventually accomplished by clamping the proximal end of the clavicle using bone forceps and rotating it while pulling it upward. Many authors have reported that closed reduction is difficult if not performed within 48 h after SCJD injury. However, we were able to achieve closed reduction approximately 72 h after injury. We found that reduction might be easily accomplished by pulling the proximal end of the clavicle up and rotating it when other closed reduction methods are unsuccessful.
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Affiliation(s)
- Tadashi Iwai
- Department of Orthopedic Surgery, Kishima Hon-in Hospital, 3-33, Gakuonji, Yao-shi, Osaka 581-0853, Japan
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka 545-8585, Japan
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka 545-8585, Japan.
| | - Kazushige Tanaka
- Department of Orthopedic Surgery, Kishima Hon-in Hospital, 3-33, Gakuonji, Yao-shi, Osaka 581-0853, Japan
| | - Mamoru Okubo
- Department of Orthopedic Surgery, Kishima Hon-in Hospital, 3-33, Gakuonji, Yao-shi, Osaka 581-0853, Japan
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Abstract
Judo is a combat sport with high risk of injury. We present a rare case of traumatic left posterior sternoclavicular (SC) joint dislocation, inflicted to a 12-year-old boy during a judo contest. An extensive literature review did not reveal any case of posterior SC joint dislocation in judo. The patient was treated with closed reduction under general anesthesia. At 2-year follow-up, his left upper extremity had full range of motion, and he did not complain of any residual symptoms. He decided to discontinue judo training; however, he participates in other physically demanding sports. Although not often encountered, posterior SC joint dislocation is a challenging and critical medical problem that can be fatal if not promptly diagnosed and treated on time and should be considered in the differential diagnosis of trauma-related anterior chest pain.
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Quinn D. Skate park injury: A new mechanism of sternoclavicular joint dislocation. Emerg Med Australas 2014; 26:316-7. [DOI: 10.1111/1742-6723.12233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- David Quinn
- Emergency Department; Gosford District Hospital; Gosford New South Wales Australia
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Perdreau A, Bingen B, Gossing L, Lejeune É, Beugnies A. Posterior sternoclavicular epiphyseal fracture-dislocation: Case report and review of literature. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.injury.2013.10.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cheng J. A rare cause of pediatric dysphagia: posterior dislocation of the sternoclavicular joint. Int J Pediatr Otorhinolaryngol 2014; 78:152-3. [PMID: 24290953 DOI: 10.1016/j.ijporl.2013.09.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 09/25/2013] [Accepted: 09/28/2013] [Indexed: 12/29/2022]
Abstract
Rarely do orthopedic injuries in children present with dysphagia. Acute onset dysphagia after falling or getting tackled with subtle symptoms or unremarkable physical examination findings should raise suspicion for posterior dislocation of the sternoclavicular joint (SCJ). A case is described and used to highlight an uncommon cause of dysphagia in children. It can be easily missed because the presenting symptoms and physical examination findings are subtle. Standard radiographs are not sufficient for diagnosis, and a high degree of suspicion is necessary to pursue further diagnostic studies. Open reduction and internal fixation can be effective for improving their symptoms, often immediately postoperatively.
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Affiliation(s)
- Jeffrey Cheng
- Division of Pediatric Otolaryngology, Cohen Children's Medical Center, New Hyde Park, NY, United States; Department of Otolaryngology - Head and Neck Surgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, United States.
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Stahel PF, Barlow B, Tepolt F, Mangan K, Mauffrey C. Safe surgical technique: reconstruction of the sternoclavicular joint for posttraumatic arthritis after posterior sternoclavicular dislocation. Patient Saf Surg 2013; 7:38. [PMID: 24378156 PMCID: PMC3898097 DOI: 10.1186/1754-9493-7-38] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 12/26/2013] [Indexed: 11/10/2022] Open
Abstract
Posttraumatic sternoclavicular arthritis related to chronic ligamentous instability after posterior sternoclavicular dislocation represents a rare but challenging problem. The current article in the Journal’s “Safe Surgical Technique” series describes a successful salvage procedure by partial resection of the medial clavicle and ligamentous reconstruction of the sternoclavicular joint with a figure-of-eight semitendinosus allograft interposition arthroplasty.
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Affiliation(s)
- Philip F Stahel
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado, School of Medicine, Denver, CO 80204, USA.
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Chotai PN, Ebraheim NA. Posterior sternoclavicular dislocation presenting with upper-extremity deep vein thrombosis. Orthopedics 2012; 35:e1542-7. [PMID: 23027495 DOI: 10.3928/01477447-20120919-27] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Posterior sternoclavicular dislocation is an uncommon injury and often remains initially undiagnosed due to variable clinical presentation and inadequate visualization of the joint on plain radiographs. It is frequently associated with serious and life-threatening injuries involving the trachea, esophagus, or great vessels. A 15-year-old boy was knocked to the ground during wrestling and landed on his left shoulder. He presented 6 days after trauma with increasing arm swelling and pain. A Doppler ultrasound revealed deep vein thrombosis involving the left shoulder and arm. Contrast-enhanced computed tomography of the chest confirmed the diagnosis of left posterior sternoclavicular dislocation with the medial end of left clavicle compressing the underlying brachiocephalic vein. Venous duplex scan confirmed acute venous thrombosis of the left jugular and subclavian veins. Open reduction of the left posterior sternoclavicular dislocation was performed under general anesthesia with cardiothoracic surgery backup. The reduced joint was stable, negating the need for internal fixation. Postoperatively, the pain and arm swelling gradually subsided, and patient recovered well with no complications. Deep vein thrombosis has not been reported as a presenting symptom for posterior sternoclavicular dislocation. Orthopedic, trauma, and thoracic surgeons should be aware of this presentation and obtain a chest computed tomography scan with 3-dimensional reconstruction to confirm the diagnosis. In cases of posterior sternoclavicular dislocation with vascular compromise, patients should immediately undergo open reduction with or without internal fixation.
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Affiliation(s)
- Pranit N Chotai
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, Ohio 43614, USA
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Garg S, Alshameeri ZA, Wallace WA. Posterior sternoclavicular joint dislocation in a child: a case report with review of literature. J Shoulder Elbow Surg 2012; 21:e11-6. [PMID: 22005127 DOI: 10.1016/j.jse.2011.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Revised: 07/05/2011] [Accepted: 07/10/2011] [Indexed: 02/01/2023]
Affiliation(s)
- Sunil Garg
- Nottingham Shoulder and Elbow Unit, City Hospital Campus, Nottingham, UK
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