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Hinz M, Kopolovich D, Kruckeberg BM, Adriani M, Kanakamedala AC, Wang Y, Rupp MC, Provencher MT, Millett PJ. Good clinical and functional outcomes with low rates of recurrent instability and revision surgery following sternoclavicular reconstruction or repair for the treatment of instability: A systematic review. Arthroscopy 2025:S0749-8063(25)00258-0. [PMID: 40209835 DOI: 10.1016/j.arthro.2025.03.061] [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: 08/02/2024] [Revised: 03/20/2025] [Accepted: 03/23/2025] [Indexed: 04/12/2025]
Abstract
PURPOSE The purpose of this systematic review was to evaluate clinical and functional outcomes after sternoclavicular joint (SCJ) reconstruction or repair and to calculate the rates of recurrent instability, revision surgery, return to sport (RTS), and return to work (RTW) after SCJ reconstruction or repair for the treatment of SCJ instability. METHODS A systematic review of the literature based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) was conducted using PubMed, Embase and Cochrane Library. Studies that evaluated the clinical and functional outcomes following SCJ reconstruction or repair for the treatment of SCJ instability were included. Data regarding study and patient characteristics, surgical management, clinical and functional outcomes as well as RTS and RTW were collected. Due to the heterogeneity of the studies included. patient-reported outcome measurements and complication rates were reported as ranges. RESULTS In total, ten studies (8x level three evidence, 2x level two evidence) with 150 patients were included for analysis, of which a reconstruction was performed in 8 studies and a repair was performed in two studies. Mean patient age ranged from 22.2 to 42 years (range, 11-73 years), and the mean follow-up time ranged from mean 28.2 to 94.5 months (range, 24 months - 13 years). A traumatic event was the most common source for SCJ instability across all studies (43.8-100%). Surgery was performed more often for anterior SCJ instability than for posterior SCJ instability. QuickDASH and ASES Score were the most commonly reported functional outcome parameters and improved from mean 44.2 to 2.3-12.1 and 44.8-50.0 to 70.8-94.8, respectively. Pain (assessed via VAS) decreased from mean 3.8-6.8 to 0-2.8 postoperatively. The recurrent instability rate was 0-10.0% and the revision SCJ surgery rate was 0-16.7%. Rates of RTS (44.4-100%) and RTW (57.2-75.0%) varied greatly among studies. CONCLUSION Reconstruction or repair of the SCJ for the treatment of SCJ instability is associated with good to excellent clinical and functional outcomes, low rates of instability recurrence and of revision SCJ surgery as well as moderate to high RTS and RTW rates. LEVEL OF EVIDENCE Level IV, systematic revie of Level III and IV studies.
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Affiliation(s)
- Maximilian Hinz
- Steadman Philippon Research Institute, Vail, CO, USA; Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | | | | | - Marco Adriani
- Steadman Philippon Research Institute, Vail, CO, USA; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - YuChia Wang
- Steadman Philippon Research Institute, Vail, CO, USA
| | - Marco-Christopher Rupp
- Steadman Philippon Research Institute, Vail, CO, USA; Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA.
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Hinz M, Kopolovich D, Kanakamedala AC, Davis C, Horan MP, Drumm A, Rupp MC, Provencher MT, Millett PJ. Minimum 10-Year Clinical and Functional Outcomes, and Return to Sport After Sternoclavicular Joint Reconstruction for Sternoclavicular Joint Instability. Am J Sports Med 2025; 53:33-38. [PMID: 39741474 DOI: 10.1177/03635465241299426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
BACKGROUND Sternoclavicular joint (SCJ) instability can lead to pain, reduced function, and an inability to perform sports and activities of daily living. Reconstruction of the SCJ using hamstring autograft in a figure-of-8 configuration has demonstrated good outcomes at short- and midterm follow-ups, but there is a paucity of literature on long-term outcomes. PURPOSE To evaluate the long-term clinical and functional outcomes after SCJ reconstruction, with a focus on return to sport, instability recurrence, and revision surgery. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who underwent SCJ reconstruction with a hamstring autograft for the treatment of SCJ instability between December 2010 and June 2013 by a single surgeon with a minimum 10-year follow-up were eligible for inclusion. Patient-reported outcome measures, including the American Shoulder and Elbow Surgeons (ASES) Score, short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, and patient satisfaction (1-10 scale, with 10 indicating maximum satisfaction), rates of return to sport, instability recurrence, and revision surgery, were evaluated at short- (2-3 years), mid- (5-8 years), and long-term (minimum 10 years) follow-ups. RESULTS Eleven patients (13 shoulders) were evaluated at a median of 10.0 years (IQR, 10.0-11.0 years) postoperatively. SCJ instability was chronic in 12 shoulders (92.3%) and acute in 1 shoulder (7.7%). One shoulder underwent revision SCJ reconstruction and was excluded from further analysis (survivorship: 92.3%). Significant pre- to postoperative improvements in shoulder function and pain were observed at short-term follow-up and were either maintained or further improved at mid- and long-term follow-ups. At a minimum of 10 years postoperatively, shoulder function (median ASES score: 95.0 [IQR, 86.2-97.5]; median QuickDASH: 12.5 [IQR, 6.8-15.9]; median SANE: 89.0 [IQR, 81.5-96.3]) was excellent, pain levels were low (median VAS for pain: 0.5 [IQR, 0-1.8]), and patient satisfaction was high (median, 9.0 [IQR, 8.0-10]). All patients returned to sport (n = 10; 100%) at levels equal to or above (n = 3; 30.0%) or slightly below (n = 7; 70.0%) their preinjury level. Two of these patients (20.0%) reported instability-related modifications in activity. One patient had recurrent instability 2.5 years postoperatively but had excellent shoulder function at the final follow-up. The overall rate of instability recurrence was 36.4% (4/11 patients). CONCLUSION SCJ reconstruction using a hamstring autograft for the treatment of SCJ instability resulted in significant improvements in shoulder function, low levels of pain, and high return-to-sport rates at long-term follow-up. Revision surgery rates were low.
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Affiliation(s)
- Maximilian Hinz
- Steadman Philippon Research Institute, Vail, Colorado, USA
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | | | | | - Caleb Davis
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Amelia Drumm
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Marco-Christopher Rupp
- Steadman Philippon Research Institute, Vail, Colorado, USA
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
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Rupp MC, Geissbuhler AR, Rutledge JC, Horan MP, Ganokroj P, Chang P, Provencher MT, Millett PJ. Predictors of Clinical Outcomes and Quality of Life After Sternoclavicular Joint Reconstruction With Hamstring Tendon Autograft. Am J Sports Med 2024; 52:3084-3093. [PMID: 39272217 DOI: 10.1177/03635465241273940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
BACKGROUND Anterior instability of the sternoclavicular joint (SCJ) is a rare but potentially devastating pathological condition, particularly when it occurs in young or active patients. SCJ reconstruction using hamstring tendon autograft is a commonly used treatment option, yet to date results are limited to small case series. Studies on baseline, preoperative factors and their association with postoperative outcome are limited. PURPOSE To assess the midterm clinical outcomes and survivorship after SCJ reconstruction using hamstring tendon autograft in patients experiencing anterior SCJ instability and to determine whether baseline patient or causative factors are associated with postoperative outcomes or patient satisfaction. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who underwent SCJ reconstruction with a hamstring tendon autograft for anterior SCJ instability between October 2005 and October 2020 were included in this retrospective single-center study. At a minimum of 2 years postoperatively, clinical outcomes were collected, including the following patient-reported outcomes (PROs): the 12-Item Short Form Survey (SF-12) score; American Shoulder and Elbow Surgeons (ASES) score; Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score; Single Assessment Numeric Evaluation (SANE) score; and visual analog scale (VAS) pain score. Subjective postoperative satisfaction with the procedure was quantified on a scale from 0 (very unsatisfied) to 10 (very satisfied). The predictive role of patient factors, including age, sex, and injury in dominant arm, on postoperative PROs and satisfaction at short-term follow-up was evaluated using multiple linear regression. RESULTS A total of 49 patients (mean age, 29.6 ± 16.2 years; range 13.8-67.1 years; 27 females) were included in the final analysis. At a mean follow-up of 3.9 ± 2.1 years, all PROs had significantly improved, including the mean SF-12 Physical Component Summary score (40.4 ± 6.8 to 52.6 ± 6.9; P < .001), ASES score (54.9 ± 20.4 to 91.0 ± 11.3; P < .001), QuickDASH score (41.2 ± 18.5 to 10.2 ± 9.1; P < .001); SANE score (50.2 ± 21.1 to 88.3 ± 8.8; P < .001), VAS pain score (4.4 ± 2.6 to 0.8 ± 1.4; P < .001), and VAS pain score at its worst (7.4 ± 2.5 to 3.3 ± 2.6; P < .001). The median postoperative satisfaction score was 9 (range, 1-10). Revision-free survivorship was 95.9%. Male patients had a significantly lower VAS pain score at its worst compared with female patients (2.6 ± 2.6 vs 4.1 ± 2.4; P = .045); higher age was significantly correlated with a worse QuickDASH score (correlation coefficient, 0.314; P = .036). Overhead athletes had a significantly lower propensity to return to sport compared with nonoverhead athletes (P = .043), with only 45% of the overhead athletes returning to a level similar to their preinjury level, whereas 81% of the nonoverhead athletes were able to do so. CONCLUSION The significant improvements in clinical and sport-specific outcomes and high patient satisfaction after SCJ reconstruction with a hamstring tendon autograft demonstrate the success of this procedure in treating anterior SCJ instability. Male sex and younger patient age are associated with superior outcomes, while overhead athletes have to be counseled about difficulties of returning to preinjury level of sport postoperatively.
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Affiliation(s)
- Marco-Christopher Rupp
- Steadman Philippon Research Institute, Vail, Colorado, USA
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | | | | | | | - Phob Ganokroj
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Peter Chang
- Department of Orthopaedic Sports Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
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Ciatti C, Masoni V, Maniscalco P, Asti C, Puma Pagliarello C, Caggiari G, Pes M, Rivera F, Quattrini F. Management Options for Traumatic Posterior Sternoclavicular Joint Dislocation: A Narrative Review with a Single Institution's Experience. J Clin Med 2024; 13:5428. [PMID: 39336915 PMCID: PMC11446411 DOI: 10.3390/jcm13185428] [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: 08/14/2024] [Revised: 09/07/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
Background: Posterior sternoclavicular joint (SCJ) dislocations are rare events that can evolve into real emergencies due to the vital structures in the mediastinum. When closed reduction maneuvers fail, open SCJ reconstruction becomes mandatory, with literature proposing several stabilization techniques that either preserve or remove the SCJ's mobility. This study is a narrative review of the most recent literature regarding posterior trauma to the SCJ along with a single institution's experience of this pathology, managed either conservatively or surgically, with a figure-of-eight autologous semitendinosus graft in case of closed reduction failure. Methods: This article provides an overview of posterior traumatic SCJ dislocation, and it describes five cases of patients managed for traumatic posterior SCJ dislocation treated either conservatively or surgically with a figure-of-eight semitendinosus tendon autograft reinforced with high-strength suture tape. A comparison with the most recent literature is performed, focusing on biomechanics. Results: The demographics, the mechanism of injury, the management algorithm and the surgical strategy align with the most recent literature. Despite the final treatment, at one year of follow-up, the ROM was restored with full strength throughout the range of motion of the shoulder with no neurological deficits. The reduced joint successfully healed in imaging, and patients returned to their daily lives. The surgical site wounds and donor harvest sites were perfectly healed. Conclusions: Although recent recommendations for treating posterior traumatic SCJ dislocation have advanced, no universally accepted method of stabilization exists, and the surgical strategy is generally entrusted to the surgeon's experience. The literature still increasingly supports figure-of-eight ligament reconstruction with a biological or synthetic graft. This work further implements the literature by reporting good outcomes at follow-up.
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Affiliation(s)
- Corrado Ciatti
- Department of Orthopedics and Traumatology, Guglielmo da Saliceto Hospital, AUSL Piacenza, 29121 Piacenza, Italy; (P.M.); (C.A.); (C.P.P.); (F.Q.)
- Department of Orthopedics and Traumatology, University of Parma, 43121 Parma, Italy
| | - Virginia Masoni
- Department of Orthopedics and Traumatology, University of Turin, Via Zuretti, 29, 10126 Turin, Italy;
| | - Pietro Maniscalco
- Department of Orthopedics and Traumatology, Guglielmo da Saliceto Hospital, AUSL Piacenza, 29121 Piacenza, Italy; (P.M.); (C.A.); (C.P.P.); (F.Q.)
- Department of Orthopedics and Traumatology, University of Parma, 43121 Parma, Italy
| | - Chiara Asti
- Department of Orthopedics and Traumatology, Guglielmo da Saliceto Hospital, AUSL Piacenza, 29121 Piacenza, Italy; (P.M.); (C.A.); (C.P.P.); (F.Q.)
- Department of Orthopedics and Traumatology, University of Sassari, 07100 Sassari, Italy; (G.C.); (M.P.)
| | - Calogero Puma Pagliarello
- Department of Orthopedics and Traumatology, Guglielmo da Saliceto Hospital, AUSL Piacenza, 29121 Piacenza, Italy; (P.M.); (C.A.); (C.P.P.); (F.Q.)
| | - Gianfilippo Caggiari
- Department of Orthopedics and Traumatology, University of Sassari, 07100 Sassari, Italy; (G.C.); (M.P.)
| | - Marco Pes
- Department of Orthopedics and Traumatology, University of Sassari, 07100 Sassari, Italy; (G.C.); (M.P.)
| | - Fabrizio Rivera
- Department of Orthopedics and Traumatology, Ospedale SS Annunziata, ASL CN1, Via Ospedali, 9, 12038 Savigliano, Italy;
| | - Fabrizio Quattrini
- Department of Orthopedics and Traumatology, Guglielmo da Saliceto Hospital, AUSL Piacenza, 29121 Piacenza, Italy; (P.M.); (C.A.); (C.P.P.); (F.Q.)
- Department of Orthopedics and Traumatology, University of Parma, 43121 Parma, Italy
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Somemura S, Shimada Y, Kano Y, Terauchi K, Niki H. Posterior Dislocation of the Sternoclavicular Joint in a Patient With Hemophilia: A Case Report. Cureus 2024; 16:e59688. [PMID: 38836138 PMCID: PMC11150050 DOI: 10.7759/cureus.59688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 06/06/2024] Open
Abstract
Posterior sternoclavicular joint (SCJ) dislocations are rare but serious injuries. We report our experience with a patient with hemophilia who experienced posterior dislocation of the SCJ and was treated with an open repair technique. A 17-year-old man with hemophilia had a posterior dislocation of the SCJ and the proximal clavicle was an approximation to the brachiocephalic artery. Cardiovascular surgeons and pediatricians were consulted on the day of injury. The patient underwent open reduction of the SCJ and the SCJ was stabilized with strong sutures using a tension-band technique. The patient returned to playing rugby three months after surgery. Posterior dislocation of the SCJ has a risk of vascular injury. Although our patient required more attention because of his hemophilia, the surgery was successful through collaboration with other departments. Reconstruction of the SCJ using a tension-band technique with strong sutures was useful and allowed early return to sports.
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Affiliation(s)
- Shu Somemura
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, JPN
| | - Yohei Shimada
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, JPN
| | - Yosuke Kano
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, JPN
| | - Koh Terauchi
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, JPN
| | - Hisateru Niki
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, JPN
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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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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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Sandler AB, Baird MD, Scanaliato JP, Harris ALW, Raiciulescu S, Green CK, Dunn JC, Parnes N. Incidence of sports-related sternoclavicular joint dislocations in the United States over the last two decades. World J Orthop 2023; 14:427-435. [PMID: 37377996 PMCID: PMC10292055 DOI: 10.5312/wjo.v14.i6.427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/01/2023] [Accepted: 05/08/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Epidemiological understanding of acute sternoclavicular (SC) dislocations secondary to sports across the United States is poorly defined.
AIM To identify and assess epidemiological trends of SC dislocations occurring secondary to sports-related mechanisms across United States over the past two decades.
METHODS This cross-sectional, descriptive epidemiological study evaluates epidemiological trends of SC dislocations from sports that present to emergency departments (EDs) across the United States. Data were obtained from the National Electronic Injury Surveillance System database spanning two decades. Data on incidence, patient demographics, mechanisms of injury, dislocation types, incident locales, and patient dispositions were collected.
RESULTS 1622 SC dislocations occurred nationwide from 2001 to 2020 [incidence = 0.262/1000000 people, confidence interval (CI) = 0.250-0.275], comprising 0.1% of shoulder/upper trunk dislocations. Most patients were male (91%, n = 1480) and aged 5-17 (61%, n = 982). Football, wrestling, and biking were the most frequently implicated sports, with contact sports responsible for 59% of athletic injuries (n = 961). Recreational vehicle-related sports injuries, such as all-terrain vehicles, dirt bikes, and mopeds accounted for 7.8% of all injuries (n = 126), with dirt bikes specifically comprising 3.7% (n = 61). Ultimately, 82% were discharged from the ED (n = 1337), 12% were admitted (n = 194), and 6% were transferred (n = 90). All recorded posterior dislocations were admitted or transferred from the ED. Patients sustaining SC dislocations from contact sports had a significantly increased risk of hospital admission or transfer rather than discharge from the ED as compared to patients whose injuries were from non-contact sports (incidence rate ratio = 1.46, CI: = 1.32-1.61, P < 0.001).
CONCLUSION SC dislocations from sports continue to be rare with a stably low incidence over the past two decades, likely comprising a smaller proportion of shoulder dislocations than previously thought. Contact sports are a frequent source of injury, especially among school-aged and teenage males. Most patients are discharged directly from the ED; however, a substantial number are hospitalized, many of which had documented posterior dislocations. Ultimately, understanding the epidemiology and mechanism-related trends of acute SC dislocations is important given the potential severity of these injuries, concentration in a specific population, and uncertainty linked to rare presentation.
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Affiliation(s)
- Alexis B Sandler
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
| | - Michael D Baird
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20307, United States
| | - John P Scanaliato
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
| | - Ayden LW Harris
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20307, United States
| | - Sorana Raiciulescu
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD 20307, United States
| | - Clare K Green
- School of Medicine and Health Sciences, The George Washington University, Washington, DC 20001, United States
| | - John C Dunn
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, NY 13619, United States
- Department of Orthopaedic Surgery, Claxton-Hepburn Medical Center, Ogdensburg, NY 13669, United States
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Han Y, Cho EH, Martinez A, Martineau PA. Sternoclavicular Joint Reconstruction with Semitendinosus Allograft and Suture Anchors after Recurrent Posterior Dislocation in a Professional North American Football Player. Open Orthop J 2022. [DOI: 10.2174/18743250-v16-e2208180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background:
Posterior sternoclavicular joint dislocations are an extremely rare but potentially life-threatening injury that can occur in sports. A variety of surgical procedures have been proposed, but there is no consensus on the treatment of choice. It is also largely unknown if a safe return to high-risk sports is possible.
Case Presentation:
We present a case of a posterior sternoclavicular joint dislocation in a 22-year-old male professional North American football player who had a recurrent irreducible posterior dislocation after initial injury management by closed reduction. The patient’s desire to return to football presented unique challenges to management. His sternoclavicular joint was subsequently reconstructed with semitendinosus allograft in a figure-of-eight augmented with suture anchors. After recovery, he returned to play as a running back in professional football symptom-free.
Conclusion:
Our patient's successful return to playing professional football after the sternoclavicular joint reconstruction suggests that this should be considered an effective treatment option when managing posterior sternoclavicular dislocation in high level contact sports players.
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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: 7] [Impact Index Per Article: 2.3] [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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Zhang Y, Xing B, Hou X, Li Y. A novel sternoclavicular hook plate for treatment of proximal clavicle fracture with dislocation of sternoclavicular join. BMC Surg 2022; 22:250. [PMID: 35768816 PMCID: PMC9241324 DOI: 10.1186/s12893-022-01703-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The aim of this study was to explore the efficacy of sternoclavicular hook plate for treatment of proximal clavicle fracture with dislocation of sternoclavicular joint. METHODS Between October 2016 and December 2020, 16 cases (9 male and 7 female patient, with a mean age of (42 ± 10) years) of proximal clavicle fracture with dislocation of sternoclavicular joint were included in the study. Injured side, injury mechanism, time to surgery, Complications and duration of follow-up were recorded. The outcomes were evaluated with radiographic assessment, American Shoulder and Elbow Surgeons' Form (ASES). All the patients were evaluated on postoperative 3rd, 6th, and 12th months. RESULTS According to the ASES scoring system, the average score was 49 ± 4 (preoperative score), 87 ± 5 (3 months follow-up), 88 ± 3 (6 months follow-up) and 91 ± 3 (12 months follow-up). Statistics differences was showed between preoperative and 3,6,12 months follow-up score of ASES score (p < 0.001). The postoperative physical function was better than the preoperative function. Internal fixation failure and fracture non-union complications in two patients. CONCLUSION Our study indicates that open reduction and sternoclavicular hook plate fixation for the treatment of traumatic sternoclavicular fracture is a safe, relatively straightforward surgical procedure that can lead to satisfactory outcomes.
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Affiliation(s)
- Yadi Zhang
- Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine, No. 31, West Huanghe Road, Yunhe, Cangzhou, 061000, Hebei, China.
| | - Baorui Xing
- Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine, No. 31, West Huanghe Road, Yunhe, Cangzhou, 061000, Hebei, China
| | - Xiuxiu Hou
- Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine, No. 31, West Huanghe Road, Yunhe, Cangzhou, 061000, Hebei, China
| | - Yunmei Li
- Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine, No. 31, West Huanghe Road, Yunhe, Cangzhou, 061000, Hebei, China
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12
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Qu Y, Xie X, Zhou W, Xia T, Cao F, Mi B, Xiong Y, Ye Z, Liu G. Operative treatment outcomes of anterior sternoclavicular joint dislocation using two experimental methods - an acromioclavicular joint hook plate versus a locking plate: a retrospective study. BMC Musculoskelet Disord 2022; 23:350. [PMID: 35410232 PMCID: PMC8996669 DOI: 10.1186/s12891-022-05293-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/14/2022] [Indexed: 09/07/2024] Open
Abstract
Background We aimed to compare the intraoperative and early postoperative clinical outcomes of using an acromioclavicular joint hook plate (AJHP) versus a locking plate (LP) in the treatment of anterior sternoclavicular joint dislocation. Methods Seventeen patients with anterior sternoclavicular joint dislocation were retrospectively analyzed from May 2014 to September 2019. Six patients were surgically treated with an AJHP, and 11 were surgically treated with an LP. Five male and one female patients composed the AJHP group, and nine male and two female patients composed the LP group. The mean age of all patients was 49.5 years. Results Reduction and fixation were performed with AJHP or LP in all 17 patients. The mean operative blood loss, operative time, and length of incision in the AJHP group were significantly better than those in the LP group. Shoulder girdle movement of the AJHP group was significantly better than that of the LP group. Conclusions This study revealed that AJHP facilitated glenohumeral joint motion, reduced the risk of rupture of mediastinal structures, required a shorter incision, and had lesser blood loss and a shorter duration of operation compared with LP. However, some deficiencies require further improvement. Supplementary information The online version contains supplementary material available at 10.1186/s12891-022-05293-x.
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Affiliation(s)
- Yanzhen Qu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Xudong Xie
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Wu Zhou
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Tian Xia
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Faqi Cao
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Bobin Mi
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Yuan Xiong
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Zhewei Ye
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Guohui Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China.
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13
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Olivier T, Kasprzak K, Herteleer M, Demondion X, Jacques T, Cotten A. Anatomical study of the sternoclavicular joint using high-frequency ultrasound. Insights Imaging 2022; 13:66. [PMID: 35380281 PMCID: PMC8982694 DOI: 10.1186/s13244-022-01167-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The purpose of the present study was to determine whether ultrasound enables assessment of sternoclavicular structures. METHODS A preliminary study in 3 cadavers was followed by an ultrasound study, performed by 2 musculoskeletal radiologists working in consensus, in 59 patients without history of trauma, surgery or pain in the sternoclavicular joint. The visibility, echogenicity and thickness of the sternoclavicular structures were assessed. RESULTS The anterior sternoclavicular ligament and the interclavicular ligament could be seen in all patients (mean thickness: 1.4 mm and 1.3 mm, respectively). The articular disc was clearly seen in 66.1% of cases, and shoulder antepulsion enabled analysis in an additional 20.3%. Intra-articular joint gas was frequent (33.89% of cases), preventing analysis of the disc in 2 patients. Only the superficial anterior aspect of the clavicular and sternal articular cartilages could be assessed. Joint effusion was seen in 6.8% of cases. Clavicular osteophytes, sternal osteophytes and bone irregularities at the anterior sternoclavicular ligament insertion were detected in 33.9%, 16.9% and 16.9% of cases, respectively. CONCLUSION The anterior sternoclavicular ligament, interclavicular ligament and anterior intra-articular structures can be visualized by ultrasound. This means of assessment may have clinical applications, particularly in patients with trauma or microtrauma.
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Affiliation(s)
- Timothée Olivier
- Service de Radiologie et Imagerie Musculosquelettique, CCIAL, CHU Lille, 59037, Lille, France
| | - Kevin Kasprzak
- Service de Radiologie et Imagerie Musculosquelettique, CCIAL, CHU Lille, 59037, Lille, France
| | - Matthias Herteleer
- Laboratoire d'Anatomie, Faculté de Médecine, Univ. Lille, Lille, France.,Unité de Taphonomie Médico-Légale et Anatomie (UTML & A), EA 7367, Univ. Lille, Lille, France.,Faculté de Médecine, Univ. Lille, Lille, France
| | - Xavier Demondion
- Service de Radiologie et Imagerie Musculosquelettique, CCIAL, CHU Lille, 59037, Lille, France.,Laboratoire d'Anatomie, Faculté de Médecine, Univ. Lille, Lille, France.,Unité de Taphonomie Médico-Légale et Anatomie (UTML & A), EA 7367, Univ. Lille, Lille, France.,Faculté de Médecine, Univ. Lille, Lille, France
| | - Thibaut Jacques
- Service de Radiologie et Imagerie Musculosquelettique, CCIAL, CHU Lille, 59037, Lille, France.,Faculté de Médecine, Univ. Lille, Lille, France.,MABLab - Marrow Adiposity and Bone Lab ULR4490-Univ. Lille, Lille, France
| | - Anne Cotten
- Service de Radiologie et Imagerie Musculosquelettique, CCIAL, CHU Lille, 59037, Lille, France. .,Faculté de Médecine, Univ. Lille, Lille, France. .,MABLab - Marrow Adiposity and Bone Lab ULR4490-Univ. Lille, Lille, France.
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14
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Ayekoloye CI, Yin Q, Wood A, Frostick S. Open sternoclavicular osteophyte debridement in the surgical management of sternoclavicular osteoarthritis: clinical outcome of a new procedure. Shoulder Elbow 2022; 14:162-168. [PMID: 35265182 PMCID: PMC8899320 DOI: 10.1177/1758573220972093] [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] [Received: 06/13/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Symptomatic sternoclavicular osteoarthritis is uncommon but remains the most frequent non-traumatic condition affecting the sternoclavicular joint and tends to have a predilection for middle-aged women. It responds well to conservative management. Surgery is indicated when conservative management fails. We present the clinical outcome of open symptomatic sternoclavicular osteophyte debridement, a new operation for treating recalcitrant symptomatic sternoclavicular osteoarthritis. METHODS Five patients (five symptomatic sternoclavicular joints) with symptomatic sternoclavicular osteoarthritis underwent open sternoclavicular debridement following failure of conservative treatment. There were three females and two males. Mean age was 46.6 years (range 37.17-66). Four cases were primary osteoarthritis and one case was secondary to trauma. They were reviewed at mean follow-up at 35.4 months with minimum follow-up of 29 months. Assessment included Quick Disabilities of Arm Shoulder and Hand (DASH) and subjective patient satisfaction score. RESULTS There was no post-operative complication. Mean Quick DASH score 10.9 (range 0-29.5) at mean 35.4-month follow-up (range 29-43 months). Three patients reported excellent and two reported good outcome as per subjective satisfaction score. CONCLUSIONS Open sternoclavicular debridement has proved to be a simple, safe and highly effective new surgical treatment for patients with symptomatic sternoclavicular osteoarthritis unresponsive to non-operative management.
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Affiliation(s)
- Charles I Ayekoloye
- Department of Orthopaedics, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK,Charles I Ayekoloye, Department of Orthopaedics, Royal Liverpool and Broadgreen Hospital, Liverpool L7 8XP, UK.
| | - Qi Yin
- Department of Orthopaedics, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK
| | - Amanda Wood
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Simon Frostick
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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15
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Reuter P, Chen K, Klestil T, Stotter C. Surgical treatment of anterior sternoclavicular dislocation associated with midshaft clavicle fracture: A case report. Jt Dis Relat Surg 2021; 32:560-565. [PMID: 34145841 PMCID: PMC8343839 DOI: 10.52312/jdrs.2021.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/07/2021] [Indexed: 12/02/2022] Open
Abstract
A combination of an anterior sternoclavicular (SC) joint dislocation with a midshaft clavicle fracture is an extremely rare injury. If left untreated, it can lead to severely impaired function of the shoulder with a high risk for complications. A 45-year-old male patient presented with pain and impaired range of motion (ROM) in the left shoulder after a mountain bike crash. Radiographs and a computed tomography scan showed an anterior dislocation of the left SC joint and an ipsilateral midshaft fracture of the clavicle. Open reduction and internal fixation (ORIF) of the clavicle combined with SC joint stabilization using transosseous sutures was performed. Postoperatively, a shoulder-arm bandage was applied with passive motion starting on the first postoperative day. During follow-up, the patient showed an improved clinical function and could return to work after three weeks. Radiographs at eight weeks showed fracture healing without any signs of recurrent SC dislocation. At the final follow-up at 12 weeks, the patient returned to his pre-injury activity level and recreational sports. Despite minimal redislocation in the SC joint, the Constant-Murley Score showed a continuous improvement with 93%, compared to the contralateral side. In conclusion, surgical treatment of anterior SC joint dislocation with a midshaft clavicle fracture can restore shoulder function with no surgery-associated complications.
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Affiliation(s)
- Philippe Reuter
- Department of Orthopaedics and Traumatology, Landesklinikum Baden-Mödling, 2340 Mödling, Austria.
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16
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Kalantar SH, Bagheri N, Bidaki M, Vosoughi F. Superior sternoclavicular joint dislocation presented with shoulder motion limitation: A case report and literature review. Int J Surg Case Rep 2021; 82:105887. [PMID: 33878670 PMCID: PMC8081913 DOI: 10.1016/j.ijscr.2021.105887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 11/27/2022] Open
Abstract
The early diagnosis of sternoclavicular dislocation is important as any undiagnosed posterior dislocation compress the mediastinum. In any patient with upper chest trauma complaining of shoulder motion limitation, this diagnosis should be considered. A few reports of superior sternoclavicular joint dislocation exist in the literature. Both surgical and non-surgical treatment can be applied for superior sternoclavicular dislocation. Conservative therapy of superior dislocation help athletic patients returning to their sport activity as soon as possible. Introduction and importance Sternoclavicular joint dislocation accounts for 1 percent of the human joint dislocations. Sternoclavicular joint dislocation most commonly occurs in anterior or posterior dislocation. To the best of the authors knowledge, only six cases of superior sternoclavicular joint dislocation are reported in the literature. The injury is commonly missed. Case presentation We present a 28-year-old athlete with upper chest pain and right shoulder range of motion limitation. On imaging, it was revealed that he had a superior sternoclavicular dislocation. He was managed with arm sling, analgesics and physiotherapy. After 3 months, he was asymptomatic and returned to his sport activity successfully. Clinical discussion We searched the published related studies and summarized the signs and symptoms of patients presented with sternoclavicular dislocation. Chest pain is one of the most common symptom while sternoclavicular tenderness and restriction of shoulder movement are among the most common signs of sternoclavicular dislocations. Conservative, close reduction, and open reduction and internal fixation with fiber wire have been applied for cases with superior sternoclavicular dislocation with acceptable results. Conclusion A high index of suspicion is needed in order not to miss sternoclavicular dislocation. In cases with no evidence of mediastinal structure compression it may be managed conservatively successfully. However, some degree of cosmetic deformity may remain at the sternoclavicular joint in those treated with conservative therapy.
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Affiliation(s)
- Seyed Hadi Kalantar
- Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nima Bagheri
- Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Morteza Bidaki
- Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Farzad Vosoughi
- Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran; Joint Reconstruction Research Center, Orthopedic Surgery Department, Imam Khomeini Hospital, End of Keshavarz Blvd, Tehran, 1419733141, Iran.
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17
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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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18
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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: 0.8] [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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19
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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: 0.2] [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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20
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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: 1.4] [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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21
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Imam MA, Javed S, Trail I, Monga P. The unicortical sternoclavicular joint reconstruction using synthetic graft. Shoulder Elbow 2020; 12:144-147. [PMID: 32313564 PMCID: PMC7153205 DOI: 10.1177/1758573218790964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/29/2018] [Indexed: 11/16/2022]
Abstract
Sternoclavicular joint injuries represent 5% of all injuries to the shoulder complex. We report a safe and reproducible technique for reconstruction of anterior sternoclavicular joint dislocations, employing a synthetic graft using a unicortical technique with minimal dissection anterior to the joint.
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Affiliation(s)
- Mohamed A Imam
- Upper Limb Research Unit, The Upper Limb Unit, Wrightington Hospital, Wigan, UK
- Trauma and Orthopaedics, Norfolk and Norwich University Hospitals NHS Foundation, Norwich, UK
| | - Saqib Javed
- Upper Limb Research Unit, The Upper Limb Unit, Wrightington Hospital, Wigan, UK
| | - Ian Trail
- Upper Limb Research Unit, The Upper Limb Unit, Wrightington Hospital, Wigan, UK
| | - Puneet Monga
- Upper Limb Research Unit, The Upper Limb Unit, Wrightington Hospital, Wigan, UK
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22
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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: 21] [Impact Index Per Article: 4.2] [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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23
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Albors LM, Lee RJ. Chronic Posterior Sternoclavicular Dislocation in a Contact Athlete: A Case Report. JBJS Case Connect 2020; 10:e0032. [PMID: 32044788 DOI: 10.2106/jbjs.cc.19.00032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE Traumatic posterior sternoclavicular dislocation (PSCD) is an uncommon injury that often presents in a delayed fashion and can be difficult to diagnose. Standard treatments include reduction of acute injuries and possible reconstruction for chronic injuries. We describe a 16-year-old male football player with a traumatic PSCD and initial dyspnea and dysphagia. He returned to playing contact sports without undergoing reduction. CONCLUSIONS Contrary to the literature that suggests reduction as a primary treatment of PSCD, this case shows that a contact-sport athlete may be able to return to competitive sports with a chronic PSCD.
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Affiliation(s)
- Laura Mena Albors
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - R Jay Lee
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
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24
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Vitali M, Drossinos A, Pironti P, Pesce E, Salini V. The management of Salter-Harris type II fracture with associated posterior sternoclavicular joint displacement using a locking compression plate: A 14-year-old adolescent's case report. Medicine (Baltimore) 2019; 98:e18433. [PMID: 31861012 PMCID: PMC6940059 DOI: 10.1097/md.0000000000018433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Posterior sternoclavicular joint dislocations (PSCJDs) are particularly rare injuries, accounting for 3% to 5% of sternoclavicular joint dislocations. With very few cases reported in the literature, these injuries are often misdiagnosed and imaging is not always clear, thus making physicians often unaware of them. The present case report aims to investigate a rare case involving a clavicular Salter-Harris II fracture with associated posterior displacement of the diaphysis, a term coined a "pseudodislocation." PATIENT CONCERNS We present a case of a 14-year-old adolescent who sustained a traumatic injury to the shoulder while falling during a soccer match. His main concern was about recovery time and the return to daily life activities. DIAGNOSES Multiple imaging studies imaging (X-rays, computed tomography, magnetic resonance imaging) revealed a Salter-Harris II fracture of the right clavicle with posterior displacement of the diaphysis. INTERVENTIONS The patient underwent primary surgery to reduce the fracture, using an articular locking compression plate, and secondary surgery to remove the hardware. OUTCOMES Following the removal of the hardware at 60 days after the initial surgery and a number of cycles of physiotherapy the patient reported a pain-free range of motion with slight limitation at extremes. Full return to recreational and everyday life activities were achieved at 3 months from the initial surgery. LESSONS The PSCJDs are challenging injuries, as they are surrounded by delicate structures inside the mediastinum. Attention must be taken while diagnosing and treating these injuries as the risk of complications and iatrogenic injuries is high. To the author's knowledge, this case is one of the first of its kind described in the literature where we have a Salter-Harrys type II fracture associated with a posterior pseudodislocation of the lateral clavicle. Given the positive results of the case, we recommend the above-mentioned treatment protocol in PSCJD with associated Salter-Harris II fractures in adolescent patients.
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Affiliation(s)
- Matteo Vitali
- Department of Orthopedics and Traumatology, San Raffaele Scientific Institute
| | - Andreas Drossinos
- Department of Orthopedics and Traumatology, San Raffaele Scientific Institute
| | - Pierluigi Pironti
- Department of Orthopedics and Traumatology, San Raffaele Scientific Institute
| | - Elisa Pesce
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Vincenzo Salini
- Department of Orthopedics and Traumatology, San Raffaele Scientific Institute
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25
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Kendal JK, Thomas K, Lo IKY, Bois AJ. Clinical Outcomes and Complications Following Surgical Management of Traumatic Posterior Sternoclavicular Joint Dislocations: A Systematic Review. JBJS Rev 2019; 6:e2. [PMID: 30399119 DOI: 10.2106/jbjs.rvw.17.00157] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Traumatic posterior sternoclavicular joint dislocations are rare orthopaedic emergencies. Treatment typically consists of closed reduction, with surgical management reserved for unstable cases. Because of the low prevalence of this condition, limited clinical evidence exists for a superior surgical stabilization technique. METHODS A systematic review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. MEDLINE and Embase databases were searched using a comprehensive search strategy. A descriptive and critical analysis of the results was performed. RESULTS Forty relevant studies (108 cases) were identified. Favorable subjective and objective outcomes were reported for all 5 categories of stabilization described. The overall complication rate was 16%, including 4 cases of recurrent instability. Ligament reconstruction using tendon graft had the lowest recurrent instability and complication rates, and open reduction and internal fixation techniques required a second operation for implant removal in 80% of cases. CONCLUSIONS A comprehensive review of the surgical management of traumatic posterior sternoclavicular joint dislocations is presented. Results suggest favorable outcomes for all of the methods of stabilization, with a modest complication rate. The trends observed have helped to guide the development of clinical care recommendations that aid in treatment decision-making for these injuries. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Joseph K Kendal
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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26
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Abstract
Sports-related injuries to the shoulder are common causes of disability. Injuries to the sternoclavicular joint (SCJ) in sports are more rare, though have been reported in a small number of cases. SCJ injury classification is determined by the degree of joint displacement and direction of clavicular displacement. Direction of displacement is particularly important due to risk of injury to intrathoracic structures, which has the potential to result in fatal outcomes. These injuries are important to identify in athletes and can be difficult to assess on the field. Specific radiographic views and use of ultrasound can improve accuracy of diagnosis. Reduction of acute traumatic SCJ dislocations is recommended and may require open reduction in the case of posteriorly displaced dislocations. Surgical treatment is indicated in cases of persistent pain or significant compression to intrathoracic soft tissue structures. Long-term outcomes are generally favorable, and athletes are able to return to sport without functional limitations.
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Affiliation(s)
- Justin E Hellwinkel
- Department of Orthopedics, School of Medicine, University of Colorado , Aurora , CO , USA
| | - Eric C McCarty
- Department of Orthopedics, School of Medicine, University of Colorado , Aurora , CO , USA
| | - Morteza Khodaee
- Department of Family Medicine and Orthopedics, School of Medicine, University of Colorado , Aurora , CO , USA
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27
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Wang H, Wang C, Ruan J, Wu W. Asymmetrical bilateral sternoclavicular joint dislocation combined with bilateral clavicular fracture: A case report. Medicine (Baltimore) 2019; 98:e16359. [PMID: 31305431 PMCID: PMC6641823 DOI: 10.1097/md.0000000000016359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Asymmetrical bilateral sternoclavicular joint (SCJ) dislocation consists of posterior SCJ dislocation on one side and anterior SCJ dislocation on the other side. This is an extremely rare injury and only a few cases have been reported in the literature. If not been diagnosed timely and accurately, asymmetrical bilateral SCJ dislocation can be life-threatening. PATIENTS CONCERNS We experienced a patient who has a life-threatening posterior dislocation of right SCJ and anterior dislocation on the left SCJ combined with bilateral clavicular fracture after a traffic accident. DIAGNOSES A computed tomography (CT) scan with three-dimensional reconstructions of SCJ showed potentially life-threatening posterior dislocation of right SCJ and anterior dislocation on the left SCJ combined with bilateral clavicular fracture. INTERVENTIONS Because of failed attempts at closed reduction, electively surgical intervention was made. We repaired the ruptured joint capsule and ligaments and fixed bilateral SCJ by Kirschner wire during the operation. OUTCOMES Three-dimensional CT scans confirmed bilateral SCJ reduction and alignment after operation 1 week as well as at the 2-month follow-up. LESSONS SCJ dislocation is an extremely rare and life-threatening injury. The aim of the operation is to repair the ruptured joint capsule and its ligaments and to fix the dislocated joints.
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Affiliation(s)
| | - Chongyang Wang
- Department of Respiration, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
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28
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Gowd AK, Liu JN, Garcia GH, Cabarcas BC, Agarwalla A, Nicholson GP, Romeo AA. Figure-of-eight Reconstruction of the Sternoclavicular Joint: Outcomes of Sport and Work. Orthopedics 2019; 42:205-210. [PMID: 31136676 DOI: 10.3928/01477447-20190523-03] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/29/2019] [Indexed: 02/05/2023]
Abstract
Instability of the sternoclavicular joint is a challenging condition given the proximity of neurovascular structures and minimal osseous constraint, and little is known regarding return to activity. A prospectively maintained institutional registry was retrospectively queried for all sternoclavicular joint reconstructions performed from 2005 to 2016. All included patients were asked to answer questions from a previously established survey to assess return to sport, work, and satisfaction following surgery. Ten patients (12 shoulders) were available for long-term follow-up (71.4%; range, 26-145 months). There were significant improvements in both visual analog scale (-2.3±3.0) and American Shoulder and Elbow Surgeons (+29.7±29.6) scores (P<.001, respectively). Seven patients reported good to excellent satisfaction, and all patients reported they would undergo the surgery again in hindsight. Regarding sports, 4 of 9 (44.4%) were able to return to sport, 1 of 9 (11.1%) was able to return to same or better intensity, and 4 of 8 (50%) were able to perform a push-up having done so prior to injury. In total, 3 of 7 (42.9%) returned to work, with 1 of 7 (14.3%) returning to same or better intensity. None of the heavy-duty workers were able to return to their preinjury level of duty. Although figure-of-eight reconstruction of the sternoclavicular joint provides consistent clinical improvement and acceptable levels of patient satisfaction, most patients were unable to return to preinjury activity. Patients should be counseled preoperatively regarding appropriate expectations. Workers with strenuous responsibilities should be advised to find alternative employment opportunities. [Orthopedics. 2019; 42(4):205-210.].
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29
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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: 0.7] [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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30
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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: 1.7] [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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31
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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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32
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Qu YZ, Xia T, Liu GH, Zhou W, Mi BB, Liu J, Guo XD. Treatment of Anterior Sternoclavicular Joint Dislocation with Acromioclavicular Joint Hook Plate. Orthop Surg 2019; 11:91-96. [PMID: 30729708 PMCID: PMC6430452 DOI: 10.1111/os.12422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 11/11/2018] [Accepted: 12/13/2018] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of using acromioclavicular joint hook plates for the treatment of anterior sternoclavicular joint dislocation. METHODS Ten patients who suffered anterior sternoclavicular joint dislocation were retrospectively analyzed, and underwent acromioclavicular joint hook plate surgeries from January 2015 to May 2017. There were 7 male and 3 female patients, with a mean age of 43.6 years. According to the American Shoulder and Elbow Society (ASES) scoring system, the preoperative physical function had a mean of 83.5. RESULTS Reduction and fixation were performed with hook plates in all 10 patients. All patients were followed up, with a mean duration of 16.9 months. There were no complications, no wound infections, and no plate or screw breakages. Movement of the shoulder girdle was improved in all patients. According to the ASES scoring system, the postoperative physical function had a mean of 94.8. CONCLUSION The acromioclavicular joint hook plate demonstrates safety and efficacy for the treatment of anterior sternoclavicular joint dislocation. However, there are still some deficiencies that need to be improved.
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Affiliation(s)
- Yan-Zhen Qu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tian Xia
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guo-Hui Liu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wu Zhou
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo-Bin Mi
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Liu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Dong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Gerich T, Hoffmann A, Backes F, Duinslaeger AD, Seil R, Pape D. Anterior buttress plate is successful for treating posterior sterno-clavicular dislocation. Knee Surg Sports Traumatol Arthrosc 2019; 27:251-258. [PMID: 30478469 DOI: 10.1007/s00167-018-5298-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/13/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Traumatic posterior instability of the sternoclavicular joint is a potentially life-threatening injury. In contrast to the low incidence there is a plethora of different strategies to treat this lesion. It was the objective of this retrospective analysis to evaluate and further develop current strategies. METHODS In this retrospective analysis all posterior dislocations that were diagnosed and treated between 2011 and 2018 were included. In this 7 year period, eight male patients (median age 32 years) were operated. RESULTS Three patients were not diagnosed at the primary institution and were referred later. Five patients were treated with an anterior buttress plate with clavicular stabilisation only. One patient was stabilized with a temporary sternoclavicular arthrodesis. Two patients were operated using an autologous tendon graft. All of the patients underwent an immediate postoperative CT-scan that documented the anatomical articulation. All patients treated with a plate underwent implant removal. A final CT examination after removal documented the maintenance of the anatomic alignment. CONCLUSIONS The buttress plate technique with clavicular screw fixation is a sufficient treatment to restore and preserve a normal sternoclavicular alignment. The technique finds its indication in unidirectional posterior instability. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Torsten Gerich
- Centre Hospitalier de Luxembourg, 4, Rue Barble, 1210, Luxembourg, Luxembourg.
| | - Alexander Hoffmann
- Centre Hospitalier de Luxembourg, 76 Rue d'Eich, 1460, Luxembourg, Luxembourg
| | - Francois Backes
- Centre Hospitalier de Luxembourg, 4, Rue Barble, 1210, Luxembourg, Luxembourg
| | | | - Romain Seil
- Centre Hospitalier de Luxembourg, 76 Rue d'Eich, 1460, Luxembourg, Luxembourg
| | - Dietrich Pape
- Centre Hospitalier de Luxembourg, 76 Rue d'Eich, 1460, Luxembourg, Luxembourg
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34
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Epiphysiolysis Type Salter I of the Medial Clavicle with Posterior Displacement: A Case Series and Review of the Literature. Case Rep Orthop 2018; 2018:4986061. [PMID: 30363614 PMCID: PMC6180938 DOI: 10.1155/2018/4986061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/29/2018] [Indexed: 12/11/2022] Open
Abstract
Physeal fractures of the medial clavicle with posterior displacement of the metaphysis are very rare injuries, but additional injuries can be life-threatening. Due to the specific clavicular ossification process, skeletally immature patients present usually not true sternoclavicular joint (SCJ) dislocations accordingly to adults but rather displaced physeal fractures. There is no consensus in the current literature on the best treatment of this lesion. Conservative treatment is not resulting in good outcome; closed reduction is often not successful, and open reduction with internal fixation is finally required. Several methods are described for stabilizing these physeal fractures. We treated three osseous immature patients with this lesion. Due to the small dimension of the medial clavicular epiphysis, we performed in one case a transosseous figure-of-eight suture of the clavicular metaphysis towards the sternum, and in the two other cases, a transosseous suture from the clavicular metaphysis on the anterior clavicular periosteum. The latter technique avoids harm to the small epiphysis or the SCJ and minimizes the risk of retrosternal complications.
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Edwin J, Ahmed S, Verma S, Tytherleigh-Strong G, Karuppaiah K, Sinha J. Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies. EFORT Open Rev 2018; 3:471-484. [PMID: 30237905 PMCID: PMC6134883 DOI: 10.1302/2058-5241.3.170078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The sternoclavicular joint (SCJ) is an integral part of the shoulder girdle that connects the upper limb to the axial skeleton. Swelling of the SCJ is commonly due to trauma, degeneration, infections and other disease processes that affect synovial joints. This review also focuses on uncommon conditions that could affect the SCJ, including SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome, Friedrich’s disease and Tietze syndrome. The scope of this review is limited to the analysis of the current evidence on the various conditions affecting the SCJ and also to provide an algorithm to manage these conditions. Cite this article: EFORT Open Rev 2018;3:471-484. DOI: 10.1302/2058-5241.3.170078
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Affiliation(s)
| | - Shahbaz Ahmed
- Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK
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Gun B, Dean R, Go B, Richardson C, Waterman BR. Non-modifiable Risk Factors Associated with Sternoclavicular Joint Dislocations in the U.S. Military. Mil Med 2018; 183:e188-e193. [DOI: 10.1093/milmed/usx095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Indexed: 11/12/2022] Open
Abstract
Abstract
INTRODUCTION
Sternoclavicular joint (SCJ) dislocations, although uncommon, are observed in patients with ligamentous laxity as well as those who experience traumatic injuries. The incidence and epidemiology of this costly and debilitating injury to our relatively young and active military population have not previously been reported. The purpose of this study is to consider and quantify the non-modifiable risk factors associated with this injury.
METHODS
Using Defense Medical Epidemiological Database, first-time occurrences, from 2006 to 2015 for the ICD-9-CM code 839.61 (closed dislocation of the SCJ), were obtained and further categorized by gender, race, age, rank, and branch of service. Race was classified based on self-reporting of patients into White, Black, or other categories. Age was divided into the categories of less than 20 yr, 20–24 yr, 25–29 yr, 30–34 yr, 35–39 yr, and greater than 40 yr. Rank was categorized as junior enlisted (E-1 to E-4), senior enlisted (E-5 to E-9), junior officer (O-1 to O-3), and senior officer (O-4 to O-10). Branch of service includes Army, Navy, Air Force, and Marines. Multivariate data analysis was performed to obtain rate per 1,000 person-years as well as adjusted rate (adjusted for age group, gender, race, rank, and service) to isolate risk factors.
RESULTS
Between 2006 and 2015, 427 cases of closed SCJ dislocations occurred among an at-risk population of 13,772,342 person-years for an unadjusted incidence rate (IR) of 0.031 per 1,000 person-years. The annual unadjusted IR ranged from 0.017 in 2006 to 0.059 in 2014 with the greatest increase occurring between 2006 and 2007 representing 61% increase in the rate of injuries. Males were almost twice as likely to sustain these injuries compared with females (adjusted rate ratio 1.73; 95% confidence interval [CI] 1.23, 2.43). Age was not found to be a risk factor for the development of these injuries with IRs for each age group overlapping with 95% CI for all other age groups. Similarly, the other category for race was also not found to be a statistically significant risk factor. Junior Officers (adjusted rate 0.017; 95% CI 0.011, 0.025) were found least likely to suffer from these injuries with Junior Enlisted (0.034; 95% CI 0.030, 0.040) and Senior Enlisted (0.032; 95% CI 0.028, 0.037) most at risk. Being in the Navy (0.019; 95% CI 0.015, 0.025) was found to be most protective compared with Air Force (0.032; 95% CI 0.026, 0.039), Army (0.036; 95% CI 0.031, 0.041), and Marines (0.036; 95% CI 0.028, 0.045).
DISCUSSION and CONCLUSION
Annual unadjusted IR of SCJ dislocations readily increased from 2006 to 2014. Statistically significant risk factors, for suffering a closed SCJ dislocation, identified by our study, were male sex, enlisted rank, and branch of service other than Navy. Age and race were not found to have a statistically significant risk. These results can shed light on non-modifiable risk factors for dislocations of the SCJ and can be used in other studies to aid in reducing injury burden on the U.S. Military.
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Affiliation(s)
- Baris Gun
- Department of Graduate Medical Education, William Beaumont Army Medical Center, 5005 N Piedras Street, El Paso, TX 79930
| | - Robert Dean
- Midwest Orthopaedics at RUSH, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612
| | - Beatrice Go
- Midwest Orthopaedics at RUSH, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612
| | - Catherine Richardson
- Midwest Orthopaedics at RUSH, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612
| | - Brian R Waterman
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, 4th Floor Watlington Hall, Medical Center Boulevard, Winston-Salem, NC 27157
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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: 1.1] [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: 0.6] [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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Katthagen JC, Marchetti DC, Dahl KD, Turnbull TL, Millett PJ. Biomechanical Comparison of Surgical Techniques for Resection Arthroplasty of the Sternoclavicular Joint. Am J Sports Med 2016; 44:1832-6. [PMID: 27159312 DOI: 10.1177/0363546516639302] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The optimal location and extent of medial clavicle resection for sternoclavicular (SC) joint resection arthroplasty are unknown. HYPOTHESIS Resection of the intra-articular disc alone cannot reliably decompress the SC joint, and a parallel resection technique will decompress the SC joint significantly more compared with the same amount with an oblique resection technique. STUDY DESIGN Controlled laboratory study. METHODS Force transmission through the SC joint was measured in 7 matched-pair human cadaveric SC joints in a dynamic tensile testing machine. The specimens were randomized to either a parallel or an oblique resection technique. An 80-N axial load was applied on the lateral clavicle toward the SC joint in each of the following 4 conditions: (1) intact joint, (2) after resecting the intra-articular disc, (3) after resecting 5 mm of the medial clavicle, and (4) after 10-mm resection. RESULTS Complete discectomy of all SC joints resulted in a significant reduction of force transmitted through the SC joint (P = .002). However, the varying anatomy of the disc was accompanied by a varying amount of joint decompression (95% CI, 29.8%-65.4%). Resecting 5 mm of the SC joint with the parallel technique decompressed the SC joint by a mean (±SD) of 76.7 ± 22.1 N compared with 37.8 ± 24.8 N with the oblique technique (P = .02). Decompression did not significantly differ between the groups after 10-mm resection (P = .18) using the parallel technique (89.4 ± 24.1 N) compared with the oblique technique (68.2 ± 31.6 N). Furthermore, 5-mm resection of the medial end of the clavicle with the parallel technique decompressed the SC joint by an amount similar to 10-mm resection with the oblique technique. CONCLUSION Resection of the disc alone did not reliably decompress each SC joint. Resection of 5 mm of the medial end of the clavicle with the parallel resection technique reliably decompressed the SC joint better than with the oblique resection technique. CLINICAL RELEVANCE This study provides baseline data on SC joint resection techniques and their mechanical effects. This knowledge can be implemented in clinical practice to treat patients with symptomatic posttraumatic arthritis of the SC joint.
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Affiliation(s)
| | | | - Kimi D Dahl
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
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Morell DJ, Thyagarajan DS. Sternoclavicular joint dislocation and its management: A review of the literature. World J Orthop 2016; 7:244-250. [PMID: 27114931 PMCID: PMC4832225 DOI: 10.5312/wjo.v7.i4.244] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 12/11/2015] [Accepted: 01/05/2016] [Indexed: 02/06/2023] Open
Abstract
Dislocations of the sternoclavicular joint (SCJ) occur with relative infrequency and can be classified into anterior and posterior dislocation, with the former being more common. The SCJ is inherently unstable due to its lack of articular contact and therefore relies on stability from surrounding ligamentous structures, such as the costoclavicular, interclavicular and capsular ligaments. The posterior capsule has been shown in several studies to be the most important structure in determining stability irrespective of the direction of injury. Posterior dislocation of the SCJ can be associated with life threatening complications such as neurovascular, tracheal and oesophageal injuries. Due to the high mortality associated with such complications, these injuries need to be recognised acutely and managed promptly. Investigations such as X-ray imaging are poor at delineating anatomy at the level of the mediastinum and therefore CT imaging has become the investigation of choice. Due to its rarity, the current guidance on how to manage acute and chronic dislocations is debatable. This analysis of historical and recent literature aims to determine guidance on current thinking regarding SCJ instability, including the use of the Stanmore triangle. The described methods of reduction for both anterior and posterior dislocations and the various surgical reconstructive techniques are also discussed.
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Sternoclavicular Reconstruction in the Young Active Patient: Risk Factor Analysis and Clinical Outcomes at Short-Term Follow-up. J Orthop Trauma 2016; 30:e111-7. [PMID: 26569185 DOI: 10.1097/bot.0000000000000483] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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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Quispe JC, Herbert B, Chadayammuri VP, Kim JW, Hao J, Hake M, Hak DJ, Stahel PF, Mauffrey C. Transarticular plating for acute posterior sternoclavicular joint dislocations: a valid treatment option? INTERNATIONAL ORTHOPAEDICS 2015; 40:1503-8. [PMID: 26257278 DOI: 10.1007/s00264-015-2952-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 07/27/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Restoration of the sternoclavicular joint after posterior dislocation is important for upper limb function. The proximity of neuro-vascular mediastinal structures makes open reduction and internal fixation (ORIF) a high-risk procedure. The ideal treatment strategy is still debated. Our aim is to review the treatment of acute posterior sternoclavicular joint dislocation with a locking compression plate. MATERIALS AND METHODS We present our experience of transarticular plating using a locking compression plate for the treatment of three consecutive patients with posterior sternoclavicular dislocation (SCD). Our primary outcome measure was objective functional outcome using DASH (disability of the arm, shoulder and hand) and PROMIS (patient-reported outcomes measurement information system) questionnaires. All patients had a minimum follow-up of six months, and serial radiographs were reviewed to evaluate maintenance of reduction. RESULTS All three patients presented a posterior SCD with instability refractory to closed reduction. In all three patients, we opted for surgical management using open reduction and fixation with a locking compression plate and allowed early mobilization at two weeks postoperatively. No complications were encountered during follow-up. Good functional outcomes were evidenced by DASH scores of 7.5, 20 and 30, and PROMIS scores were 53.8, 53.8 and 38.1 in each patient, respectively. CONCLUSION Our experience of transarticular plating using a locking compression plate for posterior SCD is positive, as it allows early mobilization and resulted in good functional outcomes.
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Affiliation(s)
- Juan C Quispe
- Department of Orthopaedics, Denver Health Medical Centre, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA
| | - Benoit Herbert
- Department of Orthopaedics, Denver Health Medical Centre, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA
| | - Vivek P Chadayammuri
- Department of Orthopaedics, Denver Health Medical Centre, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA
| | - Ji Wan Kim
- Department of Orthopaedic Surgery, Haeundae Paik Hospital, Inje University, College of Medicine, 1435, Jwa-dong, Haeundae-gu, Busan, 612-862, Republic of Korea
| | - Jiandong Hao
- Department of Orthopaedics, Denver Health Medical Centre, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA
| | - Mark Hake
- Department of Orthopaedics, Denver Health Medical Centre, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA
| | - David J Hak
- Department of Orthopaedics, Denver Health Medical Centre, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA
| | - Philip F Stahel
- Department of Orthopaedics, Denver Health Medical Centre, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA
| | - Cyril Mauffrey
- Department of Orthopaedics, Denver Health Medical Centre, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA.
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Terra BB, Rodrigues LM, Pádua DVH, Martins MG, Teixeira JCDM, De Nadai A. Luxação esternoclavicular: relato de caso e técnica cirúrgica. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2014.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Terra BB, Rodrigues LM, Pádua DVH, Martins MG, Teixeira JCDM, De Nadai A. Sternoclavicular dislocation: case report and surgical technique. Rev Bras Ortop 2015; 50:472-7. [PMID: 26401506 PMCID: PMC4563050 DOI: 10.1016/j.rboe.2015.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 07/29/2014] [Indexed: 11/06/2022] Open
Abstract
Sternoclavicular dislocations account for less than 5% of all dislocations of the scapular belt. Most cases of anterior dislocation of the sternoclavicular joint do not present symptoms. However, some patients may develop chronic anterior instability and remain symptomatic, and surgical treatment is indicated in these cases. There is a scarcity of reports in the literature relating to reconstruction using the long palmar tendon in cases of traumatic anterior instability. Although rare, these injuries deserve rapid diagnosis and efficient treatment in order to avoid future complications. The aim of this report was to report on a case of a motocross competitor who developed chronic traumatic anterior instability of the sternoclavicular joint and underwent surgical reconstruction using the autogenous long palmar tendon. The patient was a 33-year-old man with a history of anterior dislocation of the sternoclavicular subsequent to a fall during a maneuver in a motocross competition. Conservative treatment was instituted initially, consisting of use of a functional sling to treat the symptoms for 3 weeks, along with physiotherapeutic rehabilitation for 3 months. We chose to use a modification of the “figure of eight” technique based on the studies by Spencer and Kuhn. A longitudinal incision of approximately 10 cm was made at the level of the sternoclavicular joint. The graft from the ipsilateral long palmar tendon was passed through the orifices in the form of a modified “figure of eight” and its ends were sutured together. The patient was immobilized using an American sling for 4 weeks. After 6 months of follow-up, the patient no longer presented pain or instability when movement of the sternoclavicular joint was required. Minor discomfort and slight prominence of the sternoclavicular joint continued to be present but did not affect the patient's activities. Thus, the patient was able to return to racing 6 months after the operation. Our study presented a case of chronic anterior dislocation of the sternoclavicular joint that was successfully treated by using a modification of the “figure of eight” reconstruction technique. This technique was shown to be safe and effective, and it allowed the patient to fully return to his sports activities.
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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: 38] [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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Kawaguchi K, Tanaka S, Yoshitomi H, Nagai I, Sato W, Karita T, Kondo T. Double figure-of-eight reconstruction technique for chronic anterior sternoclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 2015; 23:1559-1562. [PMID: 24722676 DOI: 10.1007/s00167-014-2979-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/30/2014] [Indexed: 10/25/2022]
Abstract
Sternoclavicular joint dislocations account for <5 % of all dislocations of the shoulder girdle. Whereas most cases of anterior dislocation do not experience symptoms, some patients with anterior instability remain symptomatic and require reconstructive surgery to stabilize the sternoclavicular joint. We present the case of a 57-year-old male diagnosed with sternoclavicular joint anterior dislocation and unusual swallowing difficulty while bending the neck forward. The patient was treated using a new and effective surgical technique of sternoclavicular joint reconstruction named "double figure-of-eight" using the ipsilateral gracilis tendon. Surgical outcome was successful, based on the Rockwood SC joint rating scale, and the patient maintained excellent stability even after 2 years. This new surgical technique offers superior stability, without harvest site morbidity, to patients with rare, severe, and chronic sternoclavicular joint dislocation. Level of evidence IV.
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Affiliation(s)
- Kohei Kawaguchi
- Department of Orthopaedics Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, Japan.
| | - Sayo Tanaka
- Department of Orthopaedics Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, Japan
| | - Hiroki Yoshitomi
- Department of Orthopaedics Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, Japan
| | - Ichiro Nagai
- Department of Orthopaedics Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, Japan
| | - Wakyo Sato
- Department of Orthopaedics Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, Japan
| | - Tasturo Karita
- Department of Orthopaedics Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, Japan
| | - Taiji Kondo
- Department of Orthopaedics Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, Japan
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Goost H, Kabir K, Burger C, Pennekamp P, Röhrig H, Wirtz DC, Deborre C, Rabanus A. [Surgical treatment of sternoclavicular joint instability with tenodesis]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2015; 27:369-75. [PMID: 25900828 DOI: 10.1007/s00064-014-0310-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/15/2014] [Accepted: 03/21/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Instability of the sternoclavicular joint is a very uncommon disorder of the shoulder girdle. Acute traumatic dislocations are commonly treated nonoperatively. But severe displacement or chronic instability with recurrent symptomatic subluxation may require surgical intervention. We present our results with open reduction and internal fixation through an autologous gracilis tendon transplant or fiber tape in 8 patients treated surgically. The operative stabilisation of the sternoclavicular joint reduces pain level and improves function of the shoulder. This technique provides an effective surgical procedure for treatment of symptomatic sternoclavicular joint instability. OBJECTIVE Restoration of the function and aspect of the sternoclavicular joint. INDICATIONS Chronic and painful instabilities. CONTRAINDICATIONS Local infection, tumor. SURGICAL TECHNIQUE The gracilis tendon graft is harvested as previously described by Petersen. Direct incision over the sternoclavicular joint. Sharp dissection of the periostal sleeve and partial release of sternocleidomastoideus and pextoralis muscle. Resection of osteophytes. Careful placement of a raspatorium under the proximal clavicle and sternum to protect the mediastinal structures. Application of 2.5 or 3.2 mm drill holes to the sternum and the proximal clavicle. The gracilis tendon or the fiber tape is pulled through the drill holes in a figure of eight and then sutured. Recontruction of the joint capsule, closure of the wound. POSTOPERATIVE MANAGEMENT Gilchrist brace for 3-5 days, functional physiotherapy with a maximum abduction of 90° for 6 weeks. No carrying or lifting of weights greater than 5 kg for 3 months. RESULTS During the period from January 2006 to December 2010, 8 patients with sternoclavicular instability were treated. Four patients were treated with fiber tape and four were treated with a gracilis tendon autograft. Postoperative all patients described a reduction of pain and improved shoulder function. The Constant score was 72 points, the DASH 58 points.
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Affiliation(s)
- H Goost
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universtitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53125, Bonn, Deutschland,
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Thyagarajan D, Webb M, Wallace A. A rare case of floating clavicle and a novel technique for stabilizing the sternoclavicular joint. Shoulder Elbow 2015; 7:44-48. [PMID: 27582956 PMCID: PMC4935098 DOI: 10.1177/1758573214536534] [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: 10/29/2013] [Accepted: 04/09/2014] [Indexed: 02/05/2023]
Abstract
We present the first ever case report of a floating clavicle with a unique combination of a posterior sternoclavicular joint dislocation and an associated grade III acromioclavicular joint dislocation. We treated this injury surgically by stabilizing both ends of clavicle using a polyester surgical mesh device (LockDown™; Mandaco 569 Limited, Redditch, UK; previously called the Nottingham Surgilig).
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Affiliation(s)
| | - Mark Webb
- Countess of Chester Hospital, Chester, UK
| | - Angus Wallace
- Nottingham Shoulder & Elbow Unit, Nottingham City Hospital, Nottingham, UK
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Negri JH, Malavolta EA, Assunção JH, Gracitelli MEC, Pereira CAM, Bolliger Neto R, Croci AT, Ferreira Neto AA. Assessment of the function and resistance of sternoclavicular ligaments: A biomechanical study in cadavers. Orthop Traumatol Surg Res 2014; 100:727-31. [PMID: 25261174 DOI: 10.1016/j.otsr.2014.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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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50
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Merriman JA, Villacis D, Wu B, Patel D, Yi A, Hatch GFR. Does patient sex affect the anatomic relationships between the sternoclavicular joint and posterior vascular structures? Clin Orthop Relat Res 2014; 472:3495-506. [PMID: 25113266 PMCID: PMC4182408 DOI: 10.1007/s11999-014-3853-x] [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] [Received: 12/28/2013] [Accepted: 07/25/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite increased concern for injury during surgical reconstruction of the sternoclavicular joint, to our knowledge there are few studies detailing the vascular relationships adjacent to the joint. QUESTIONS/PURPOSES We investigated sex differences in the following relationships for sternoclavicular joint reconstruction: (1) safe distance from the posterior surface of the medial clavicle's medial and lateral segments to the major vessels, (2) length of the first costal cartilage and safe distance from the first rib to the internal mammary artery, (3) minimum distance medial to the sternoclavicular joint for optimal hole placement, and (4) safe distance from the manubrium to the great vessels. METHODS Fifty normal postcontrast CT scans of the chest were reviewed. Means, standard deviations, and 95% CI were calculated for each aforementioned measurement. A t-test was used to determine if a sex difference exists (p≤0.05). RESULTS At the medial end of the clavicle, the safe distance from the medial segment (first 10 mm) to the major vessels was greater in males than in females (3.5 mm versus 2.4 mm, respectively; 95% CI, 3 mm-4 mm versus 1.7 mm-3 mm, respectively; p=0.014). For the lateral segment (next 10 mm), the distance also was safer in males than in females (3.3 mm versus 1.7 mm, respectively; 95% CI, 2.7 mm-4 mm versus 1.1 mm-2.3 mm, respectively; p<0.001). The mean length of the first costal cartilage also was greater in males (35.8 mm versus 30.1 mm, respectively; 95% CI, 33.8 mm-37.8 mm versus 28.5 mm-31.9 mm, respectively; p<0.001); the distance from the first costochondral joint to the internal mammary artery was safer in males than in females (19.1 mm versus 15.4 mm, respectively; 95% CI, 16.5 mm-21.8 mm versus 13 mm-17.9 mm, respectively; p=0.05). The minimum distance to avoid inadvertent penetration of the sternoclavicular joint was greater in males than in females (16 mm versus 12.3 mm, respectively; 95% CI, 14.6 mm-17.5 mm versus 11 mm-13.6 mm, respectively; p<0.001). The distance to vessels after penetration of the manubrium was not different between males and females (5.6 mm versus 3.9, respectively; 95% CI, 4.4 mm-6.8 mm versus 2.6 mm-5.2 mm, respectively; p=0.06). CONCLUSIONS This study makes apparent the intimate relationships between vessels and the musculoskeletal structures associated with sternoclavicular reconstruction. Based on our findings, we recommend considering the sex of the patient, using caution when drilling, and protecting essential structures posterior to the joint.
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Affiliation(s)
- Jarrad A. Merriman
| | - Diego Villacis
| | - Brian Wu
| | - Dakshesh Patel
| | - Anthony Yi
| | - George F. Rick Hatch
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