Manubriosternal disjunction a new approach for surgical repair

New reduction technique simplified for surgical stabilisation of isolated manubriosternal dislocation: A case report and literature review

Manubriosternal joint (MSJ) dislocation is often poorly tolerated, with pain, and both static and dynamic dysfunction in breathing. This injury is rare, and treatment includes both surgical and non-surgical interventions. Moreover, the treatment needs to be personalised to a specific case. We present a case of a 19-year-old Comorian man who had chest pains that were exacerbated by movements after falling from a tree. Careful physical examination revealed that the man had a ‘stair step’-looking deformity located at the anterior chest wall at the level of the MSJ. A computed tomography scan confirmed the diagnosis of manubriosternal disruption. The patient underwent a surgical intervention under general anaesthesia and had an uneventful recovery.

Operative Reduction and Fixation of a Sternomanubrial Dislocation: A Case Report and Literature Review

A dislocation of the sternomanubrial joint is a rare injury with varied treatment methods including both nonoperative and operative described methods. There is a paucity of literature regarding the optimal method of treatment as well as a lack of consensus on the best surgical construct. This case demonstrates the successful use of dual locking plate fixation for an acute type II sternomanubrial dislocation in a 22-year-old man. In principle, locking plate fixation affords greater unicortical fixation than traditional nonlocking fixation, and allows for minimising the risk of damage to pulmonary tree structures. The patient achieved good pain relief and regained physical function.

OCCULT MANUBRIOSTERNAL JOINT INJURY ASSOCIATED WITH FRACTURE OF THE THORACIC SPINE

The authors report the occurrence of an occult manubriosternal joint injury in the initial evaluation on a patient with a thoracic spine fracture (T9). This T9 fracture was diagnosed in a 37-year-old man and was associated with a partial neurological deficit. At the initial evaluation, the radiographs produced did not show the manubriosternal joint injury. During rehabilitation, after surgical stabilization of the thoracic spine fracture, the patient suddenly felt an intense pain accompanied by deformation at the sternal level. From imaging examinations, manubriosternal luxation was diagnosed. Because of recurrence of the luxation and the incapacitating pain, open reduction and fixation of the manubriosternal joint had to be performed. At the 12-month follow-up, the patient presented complete recovery of the neurological lesion, consolidation of the arthrodesis on the T7-T11 vertebral segment and maintenance of the reduction of the manubriosternal joint, which was asymptomatic during daily activities.

Osteosynthesis of traumatic manubriosternal dislocations and sternal fractures with a 3.5/4.0 mm fixed-angle plate (LCP)

INTRODUCTION

We present a case series of three patients with manubriosternal dislocation and/or sternal fractures.

METHOD

We describe our experiences of invasive surgical treatment with 3.5/4.0 mm fixed-angle plate (Locking compression plate, LCP) in this group of patients. Recommended nonoperative treatment options, e.g. correction tape or plaster bandage, symptomatic pain treatment, application of ice, and several weeks without sports are associated with a not inconsiderable rate of subluxations or reluxations with an increased risk of pseudarthrosis and chronic pain syndrome.

RESULTS

Due to a small number of cases and the lack of controlled studies, a standardized operative procedure could, therefore, so far not been established.

CONCLUSION

Our positive experiences with the operative treatment using 3.5/4.0 mm fixed-angle plate (LCP) may help to establish the operative procedure of first choice in this group of patients.

Traumatic manubriosternal dislocation: A new method of stabilization postreduction

Traumatic manubriosternal dislocation is a rare lesion. In the literature, only a few case reports of patients treated surgically are published. In this case, we report an unstable posterior dislocation of the manubriosternal joint in a 50-year-old women caused by direct trauma. An open reduction was performed, and the manubriosternal joint was fixed by two staples. We are the first to use this alternative technique. At the last follow-up, the result was very good without complication.