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Plath JE, Martetschläger F, Moroder P, Sandmann G. Instabilities and Osteoarthritis of the Sternoclavicular Joint. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:360-367. [PMID: 37647924 DOI: 10.1055/a-2109-3190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Injury to the sternoclavicular joint (SCG) is very rare, accounting for 3% of shoulder injuries and < 1% of instabilities. Consequently, both the treatment of acute instabilities and their subsequent states (chronic instabilities/SCG arthrosis) are controversial. While treatment has so far been mostly conservative, in recent years there has been a trend towards surgical therapy.Considerable violence, such as that found in traffic accidents or contact sports, can tear the extremely stable ligaments between the medial clavicle and sternum. While anterior dislocation is easier to reduce in most cases, instability remains in up to 50% of cases. In most cases, posterior instability requires rapid reduction, particularly due to the anatomical proximity to important cardio-pulmonary structures. If this succeeds, the rate of persistent instabilities is low. For chronic instability, reconstruction/augmentation of the ligament apparatus with tendon grafts in the "Figure of 8 configuration" has proven to be the standard technique in recent years.
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Affiliation(s)
| | | | - Philipp Moroder
- Abteilung Schulterchirurgie und Ellenbogenchirurgie, Schulthess Klinik Zürich, Zürich, Schweiz
| | - Gunther Sandmann
- Sportklinik Ravensburg, Sportklinik Ravensburg, Ravensburg, Deutschland
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2
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Walia P, Fredette R, Mortimer E. Missed Medial Clavicular Physeal Fracture-Posterior Dislocation Complicated by Brachiocephalic Pseudoaneurysm: A Case Report. JBJS Case Connect 2024; 14:01709767-202409000-00036. [PMID: 39172876 DOI: 10.2106/jbjs.cc.24.00180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
CASE We present a 17-year-old male patient with an initially missed posterior sternoclavicular fracture dislocation who presented with symptoms related to thrombotic emboli arising from a pseudoaneurysm. He was treated 6 weeks after injury with a figure-of-eight tendon allograft repair with good clinical outcomes. CONCLUSION This is a unique presentation that highlights the significant risk of a missed diagnosis, life-threatening complications that may ensue, and biomechanically superior surgical intervention.
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Affiliation(s)
- Palak Walia
- Department of Orthopedics, University of Massachusetts Chan Medical Center, Worcester, Massachusetts
- University of Massachusetts Chan Medical Center, Worcester, Massachusetts
| | - Ryan Fredette
- University of Massachusetts Chan Medical Center, Worcester, Massachusetts
| | - Errol Mortimer
- Department of Orthopedics, University of Massachusetts Chan Medical Center, Worcester, Massachusetts
- University of Massachusetts Chan Medical Center, Worcester, Massachusetts
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3
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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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Kobayashi T, Matsumura N, Tasaki A, Kiyota Y, Suzuki T, Iwamoto T, Matsumoto M, Nakamura M. Extra-Articular Stabilization for the Treatment of Recurrent Sternoclavicular Joint Instability: A Report of Two Cases. JBJS Case Connect 2024; 14:01709767-202406000-00020. [PMID: 38669445 DOI: 10.2106/jbjs.cc.24.00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
CASE A 22-year-old man and a 14-year-old adolescent boy, who exhibited moderate general joint laxity, experienced recurrent sternoclavicular joint instability without traumatic events. The patients were successfully treated with extra-articular stabilization using autologous tendon grafts without surgical exposure of the sternoclavicular joint. CONCLUSION Atraumatic instability of the sternoclavicular joint is rare but often results in recurrent instability accompanied by discomfort, pain, and limitations in activities. Extra-articular stabilization, which reinforces the anterior capsule of the sternoclavicular joint and prevents anterior displacement of the proximal clavicle at the elevated arm position, could be a viable surgical option for this pathological condition.
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Affiliation(s)
- Takayuki Kobayashi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Atsushi Tasaki
- Department of Orthopedic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Yasuhiro Kiyota
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Taku Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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5
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Heaton D, Wang Y, Moore B, Frager L, Everist BM, Crist J. Utility of 3D reformatted images in the diagnosis of sternoclavicular joint injury. Arch Orthop Trauma Surg 2024; 144:741-745. [PMID: 38055015 DOI: 10.1007/s00402-023-05135-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION The purpose of this study is to evaluate the ability of musculoskeletal radiologists to diagnose sternoclavicular joint injuries in the standard CT imaging planes compared to 3D volume rendered images to define the most accurate plane to improve prospective diagnosis. MATERIALS AND METHODS A retrospective query of our institutional database was performed. Twenty-six patients with a diagnosis of sternoclavicular joint injury, who had been evaluated with CT and treated by orthopedic surgery, and 30 control patients who did not have a sternoclavicular joint injury were included for analysis. Two blinded radiologists with specialty training in musculoskeletal radiology independently reviewed axial, coronal, sagittal, and 3D reformatted CT images and documented whether injury was present or not present. RESULTS Accuracy was good for both radiologists on all views. It was lowest on the sagittal view for both readers. Accuracy was highest for the 3D view. When comparing the accuracy of the four views for each radiologist, there was a significant difference for Radiologist A, whose 3D images were more accurate compared to the axial and sagittal views. There was no significant difference for Radiologist B. There was good inter-reader agreement, which was highest on the 3D images. CONCLUSION 3D volume renderings of the sternoclavicular joints have the potential to improve radiologist accuracy for detection of sternoclavicular joint injury/dislocation in the setting of chest well trauma, which could decrease instances of missed or delayed diagnosis.
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Affiliation(s)
- Dennis Heaton
- University of Kansas Health System, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Yang Wang
- University of Kansas Health System, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Brittany Moore
- Kansas City Orthopedic Alliance, 10777 Nall Ave Suite 300, Overland Park, KS, 66211, USA
| | - Luke Frager
- University of Kansas Health System, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Brian M Everist
- University of Kansas Health System, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Jamie Crist
- University of Kansas Health System, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
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Gurcinar MG, Ozer M, Afacan MY, Ustundag S. Management of Posterior Sternoclavicular Joint Dislocation in a Teenager After a Direct Elbow Strike to His Clavicle: A Case Report. Cureus 2023; 15:e49916. [PMID: 38174173 PMCID: PMC10763836 DOI: 10.7759/cureus.49916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Posterior dislocation of the sternoclavicular joint is a rare orthopedic injury and may result in complications with high mortality due to the location of the joint, accompanied by neurovascular, tracheal, and esophageal injuries. Therefore, an immediate diagnosis and treatment are necessary to prevent complications. In this case, a 13-year-old male patient received an elbow strike to the left clavicle while playing football. The patient presented to the emergency department with complaints of pain, a gap and deformity in the superior and medial part of his sternum, and numbness in his left upper extremity. For this orthopedic emergency, which is difficult to recognize on direct radiographs, a computed tomography was done, which detected a left sternoclavicular joint posterior dislocation. A closed reduction procedure was performed on the patient under sedation in the operating theatre. A serendipity view with the fluoroscopy showed a successful closed reduction. A shoulder arm sling was applied and the patient was followed regularly. In the fourth week, the shoulder arm sling was removed and exercises were started to increase joint movements. In the sixth week, muscle strengthening exercises were started and in the eighth week, a full range of motion was reached with full muscle strength without any deformity. In this case, possible mortal complications were prevented with early intervention in the posterior dislocation of the sternoclavicular joint. This case report shows that with timely rehabilitation, it is possible to achieve full joint range of motion of the shoulder and full muscle strength without deformity or the need for surgery.
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Affiliation(s)
- Mahmut Gorkem Gurcinar
- Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, TUR
| | - Mete Ozer
- Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, TUR
| | - Muhammed Yusuf Afacan
- Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, TUR
| | - Sinan Ustundag
- Department of Orthopaedics and Traumatology, Istanbul Gelisim University, Istanbul, TUR
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Helvey-Byers R, O'Laughlin J, Dickson N, Myer R, Gross M. Acromioclavicular joint mobilizations for the management of grade I sternoclavicular joint sprain: a case report. Physiother Theory Pract 2023:1-9. [PMID: 37916522 DOI: 10.1080/09593985.2023.2276378] [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: 08/16/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Injury to the sternoclavicular joint is a rare phenomenon that has implications for the shoulder complex. Limited literature exists on optimal physical therapy rehabilitation after a sternoclavicular ligament sprain. This case report details the physical therapy management and outcomes of a patient with a posterior sternoclavicular joint sprain. CASE DESCRIPTION The patient was a 34-year-old female who sustained a grade I posteriorly directed sternoclavicular sprain during a motor vehicle accident. She received a combination of acromioclavicular joint mobilizations and therapeutic exercise for her shoulder complex for five sessions over six weeks. OUTCOMES At discharge, the patient surpassed the minimally clinically important difference (MCID) and the minimal detectable change (MDC) in her Quick-DASH score. She surpassed the MDC and MCID in her Numerical Pain Rating Scale score. She was able to regain full functional use of her involved upper extremity and returned to her work and original exercise regimen with no further limitations. CONCLUSION The outcomes suggest that a combination of acromioclavicular joint mobilizations and therapeutic exercise for the shoulder complex was a suitable option for the conservative management of this patient's grade I sternoclavicular sprain.
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Affiliation(s)
| | - Jeffrey O'Laughlin
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nicole Dickson
- Department of Physical Therapy, UNC Health Therapy Services, Chapel Hill, NC, USA
| | - Reuben Myer
- Department of Physical Therapy, UNC Health Therapy Services, Chapel Hill, NC, USA
| | - Michael Gross
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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8
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Gobbell W, Edwards CM, Engel SR, Coyner KJ. Atraumatic Sternoclavicular Joint Instability: Prevalence, Etiology, and Management. Clin Sports Med 2023; 42:723-737. [PMID: 37716734 DOI: 10.1016/j.csm.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Sternoclavicular joint instability is a rare complaint in the orthopedic clinic, but patients can experience chronic pain and functional impacts. Causes of instability may be posttraumatic, infectious, autoimmune, degenerative, or secondary to generalized laxity. Conservative treatment is the initial approach to management and involves activity modification, physical therapy, oral nonsteroidal anti-inflammatory drugs, and corticosteroid injections. Surgery is indicated when conservative treatment does not manage symptoms. Figure-of-eight reconstruction techniques provide greatest biomechanical strength but are associated with risk of neurovascular injury. Other reconstruction methods have been shown to mitigate these risks with favorable short-term outcomes.
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Affiliation(s)
- Wade Gobbell
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Christopher M Edwards
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Samuel R Engel
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Katherine J Coyner
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA.
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9
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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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10
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Schut SM, Shannon KN. Multimodal Chiropractic Management of a Postsurgical Sternoclavicular Injury Utilizing Gamified Rehabilitation: A Case Report. J Chiropr Med 2023; 22:230-233. [PMID: 37644998 PMCID: PMC10461152 DOI: 10.1016/j.jcm.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 08/31/2023] Open
Abstract
Objective The purpose of this study was to describe how gamification was incorporated into postoperative rehabilitation of a patient recovering from a sternoclavicular dislocation. Clinical Features A 23-year-old man sought chiropractic care from an academic chiropractic clinic for persistent right-sided, sternoclavicular joint, moderate-to-severe pain that was exacerbated with shoulder movements and overhead activities. His shoulder was treated previously with reconstructive surgery and a 6-week trial of physical therapy; however, he reported minimal improvement in his pain, and his functional ability was suboptimal. Intervention and Outcome Multimodal chiropractic treatment consisted of manual therapy in conjunction with active rehabilitation. The rehabilitation program incorporated gamification principles, such as competition, point scoring, and task focus. After 8 treatments, a clinically significant reduction in his upper extremity functional index score and numerical pain rating was observed. Conclusion The patient was managed using a gamified approach to postsurgical sternoclavicular joint rehabilitation and responded positively. Chiropractors may consider including gamified, multimodal care for patients with postoperative musculoskeletal concerns.
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Damschen J, Nowak M, Murphy A, Park S, Li X, Galvin J. Return to Sports After Closed Reduction of Acute Traumatic Posterior Sternoclavicular Joint Dislocations: A Systematic Review. Am J Sports Med 2023; 51:3076-3083. [PMID: 36472354 DOI: 10.1177/03635465221131900] [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: 12/12/2022]
Abstract
BACKGROUND Acute traumatic posterior sternoclavicular (SC) joint dislocation is a serious injury given its potential to cause cardiovascular and airway compromise that typically will require emergent closed reduction. There are limited data on the rate of return to sports (RTS) after this injury pattern when treated in a closed fashion. PURPOSE To systematically review the literature and evaluate (1) the rate of RTS after closed reduction of posterior SC dislocation and (2) the timeline for RTS after closed reduction of posterior SC dislocation. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review was performed using the PubMed, EBSCOhost, and Elsevier databases with the search term "sternoclavicular dislocation." Inclusion criteria were publications reporting successful closed reduction of posterior SC joint dislocation and containing data relevant to the study objectives. Exclusion criteria were cases with unsuccessful closed reduction, open surgical reduction, concomitant fracture, epiphyseal disruption, superior or anterior dislocation, subluxation injury, treatment without reduction, and atraumatic or congenital origins. RESULTS Sixteen studies and an additional forthcoming case at the authors' institution were identified to have documented RTS with a total of 31 patients. Of these patients, 23 (74%) in the cohort had full RTS. Eight of the 16 studies plus the additional case reported a timeline for RTS. The mean time to RTS was 3.1 months (range, 1-6 months). Of the 8 patients who did not return to preinjury sports or activity, 12.9% (4/31) reported restrictions with sports or activity, 6.5% (2/31) changed to a sport with less contact, 3.2% (1/31) experienced symptomatic recurrence requiring surgical stabilization, and 3.2% (1/31) quit the sport. CONCLUSION Closed reduction of acute traumatic posterior SC joint dislocations provides high RTS rates with low rates of secondary surgical stabilization. The mean time to RTS at the preinjury activity level was 3.1 months.
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Affiliation(s)
| | - Matthew Nowak
- Madigan Army Medical Center, Tacoma, Washington, USA
| | | | | | - Xinning Li
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Joseph Galvin
- Madigan Army Medical Center, Tacoma, Washington, USA
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12
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Tomesch AJ, Negaard M, Keller-Baruch O. Chest and Thorax Injuries in Athletes. Clin Sports Med 2023; 42:385-400. [PMID: 37208054 DOI: 10.1016/j.csm.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Injuries to the chest and thorax are rare, but when they occur, they can be life-threatening. It is important to have a high index of suspicion to be able to make these diagnoses when evaluating a patient with a chest injury. Often, sideline management is limited and immediate transport to a hospital is indicated.
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Affiliation(s)
- Alexander J Tomesch
- Department of Emergency Medicine, University of Missouri, Columbia, MO, USA.
| | - Matthew Negaard
- Department of Emergency Medicine, University of Iowa, Iowa City, IA, USA; Forte Sports Medicine and Orthopedics, Indianapolis, IN, USA. https://twitter.com/MattNegaard
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Tunnicliffe H, Athanatos L, Singh H, Armstrong A. Physiotherapy management of atraumatic anterior sternoclavicular joint instability: A prospective case series. Shoulder Elbow 2023; 15:337-343. [PMID: 37325385 PMCID: PMC10268145 DOI: 10.1177/17585732221088268] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/25/2022] [Accepted: 02/01/2022] [Indexed: 09/20/2023]
Abstract
Background Atraumatic sternoclavicular joint (SCJ) instability is rare. Long-term outcomes are presented for patients managed with physiotherapy. A standardised method of assessment and treatment with a structured physiotherapy programme is also presented. Methods Long-term outcome was analysed in this prospectively collected series (2011-2019) of patients who were assigned to a structured physiotherapy programme for atraumatic SCJ instability. Outcome-measures (subjective SCJ grading of joint stability (SSGS score), Oxford shoulder instability score (OSIS adapted for SCJ) and visual analogue scale (VAS) for pain) were collected at discharge and long-term follow up. Results 26 patients (29 SCJ's) responded (return rate 81%). Mean follow-up was 5.1 years (range 0.9-8.3 years). 17/26 patients were hyperlax. 93% (27/29) of SCJs achieved a stable joint on SSGS score. Mean OSIS score at long-term follow up was 33.4 (range 3-48) and VAS 2.7 (range 0-9). 95% who were compliant with physiotherapy had a stable SCJ (mean OSIS 37.8 (SD 7.3) and VAS 1.6 (SD 2.1)). Those non-compliant, 90% were stable but had lower function (mean OSIS 25 (SD 14, p = 0.02) and more pain, VAS 4.9 (SD 2.9, p = 0.006). Conclusion The structured physiotherapy programme is highly effective in treating patients with atraumatic SCJ instability. Compliance was essential in ensuring better outcomes.
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Affiliation(s)
| | - Lambros Athanatos
- Lambros Athanatos Surgical Trainee, Orthopaedics, University Hospitals of Leicester, Leicester, UK
| | - Harvinder Singh
- Lambros Athanatos Surgical Trainee, Orthopaedics, University Hospitals of Leicester, Leicester, UK
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14
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Tytherleigh-Strong G, Cuthbert R, Poutoglidou F, Tang Q. Magnetic Resonance Imaging in the Management of Significantly Displaced Adolescent Posterior Sternoclavicular Joint Injuries. J Pediatr Orthop 2023; 43:e374-e382. [PMID: 36863880 DOI: 10.1097/bpo.0000000000002378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Computed tomography (CT) scans are the standard imaging modality for the diagnosis and treatment guide for adolescent posterior sternoclavicular joint (SCJ) injuries. However, the medial clavicular physis is not visualized and it is not possible to differentiate between a true SCJ dislocation and a physeal injury (PI). An magnetic resonance imaging (MRI) scan can visualize the bone and the physis. METHODS We treated a series of patients with adolescent posterior SCJ injuries diagnosed on CT scan. Patients underwent an MRI scan to differentiate between a true SCJ dislocation and a PI and to further differentiate between a PI with or without residual medial end clavicular bone contact. Patients with a true SCJ dislocation and a PI with no contact underwent an open reduction and fixation. Patients with a PI with contact were treated nonoperatively with repeat CT scans at 1 and 3 months. At final follow-up SCJ clinical function was assessed using Quick-DASH, Rockwood, modified Constant, and single assessment numeric evaluation (SANE) scores. RESULTS Thirteen patients (2 female and 11 male) with an average age of 14.9 years (12 to 17) were included in the study. Twelve patients were available at final follow-up (mean 50 mo, 26 to 84). One patient had a true SCJ dislocation and 3 had an off-ended PI and were treated with an open reduction and fixation. Eight patients had a PI with residual bone contact and were treated nonoperatively. For these patients serial CT scans showed that the position was maintained, with a serial increase in callus formation and bone remodeling. The average follow-up was 42.9 months (24 to 62). At final follow-up the mean Quick-disabilities of the arm, shoulder and hand (DASH) was 0.4 (0 to 2.3), Rockwood was 15, modified Constant was 98.8 (89 to 100) and SANE was 99.5% (95 to 100). CONCLUSION In this case series of significantly displaced adolescent posterior SCJ injuries MRI scans allowed identification of true SCJ dislocations and off-ended PIs, which were successfully treated by open reduction, and PIs with residual physeal contact which were successfully treated nonoperatively. LEVEL OF EVIDENCE Level IV-case series.
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Affiliation(s)
- Graham Tytherleigh-Strong
- Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals Trust, Hills Road, Cambridge, UK
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15
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Burns S, Thangarajah T, Lambert S. Two cases of sternoclavicular joint replacement arthroplasty: A case report. A novel prosthesis and surgical technique for recalcitrant instability, arthropathy of the sternoclavicular joint with medial clavicular bone loss. SAGE Open Med Case Rep 2023; 11:2050313X231153032. [PMID: 36798681 PMCID: PMC9926365 DOI: 10.1177/2050313x231153032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 01/09/2023] [Indexed: 02/15/2023] Open
Abstract
Instability arthropathy of the sternoclavicular joint is most commonly managed by rehabilitation, injection, and either arthroscopic or open debridement with or without interposition arthroplasty. When these options fail to achieve symptom relief, excision arthroplasty is an option. This is associated with a risk of persistent instability and incomplete pain relief. We describe two cases in which custom sternoclavicular joint replacement was performed for painful insufficiency of scapular suspension. Although the prostheses remained secure in both cases, the first case was complicated by persistent instability due to insufficient reconstruction of the intrinsic sternoclavicular capsular ligaments. This was recognised and corrected for in the second case, in which stability of the sternoclavicular joint replacement has been noted on more than a 5-year review. We conclude that sternoclavicular joint replacement is an option for patients in whom instability arthropathy remains an intrusive problem in daily life after other conventional treatments have not controlled symptoms. Stability of the joint remains a concern. We offer one method of achieving stability through an iterative design process including the ability to reconstruct the intrinsic capsular ligaments around the articulation.
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Affiliation(s)
- Sophia Burns
- Trauma and Orthopaedic Department, University College London Hospitals, London, UK,Sophia Burns, Trauma and Orthopaedic Department, University College London Hospitals, 250 Euston Road, London NW1 2PG, UK.
| | - Tanujan Thangarajah
- Department of Shoulder & Elbow Surgery, University of Calgary, Calgary, AB, Canada
| | - Simon Lambert
- Trauma and Orthopaedic Department, University College London Hospitals, London, UK
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16
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Athanatos L, Kulkarni K, Tunnicliffe H, Samaras M, Singh HP, Armstrong AL. Midterm results of chronic anterior instability of the sternoclavicular joint managed using a standardized treatment algorithm. Bone Jt Open 2022; 3:815-825. [PMID: 36263725 PMCID: PMC9626857 DOI: 10.1302/2633-1462.310.bjo-2022-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS There remains a lack of consensus regarding the management of chronic anterior sternoclavicular joint (SCJ) instability. This study aimed to assess whether a standardized treatment algorithm (incorporating physiotherapy and surgery and based on the presence of trauma) could successfully guide management and reduce the number needing surgery. METHODS Patients with chronic anterior SCJ instability managed between April 2007 and April 2019 with a standardized treatment algorithm were divided into non-traumatic (offered physiotherapy) and traumatic (offered surgery) groups and evaluated at discharge. Subsequently, midterm outcomes were assessed via a postal questionnaire with a subjective SCJ stability score, Oxford Shoulder Instability Score (OSIS, adapted for the SCJ), and pain visual analogue scale (VAS), with analysis on an intention-to-treat basis. RESULTS A total of 47 patients (50 SCJs, three bilateral) responded for 75% return rate. Of these, 31 SCJs were treated with physiotherapy and 19 with surgery. Overall, 96% (48/50) achieved a stable SCJ, with 60% (30/50) achieving unrestricted function. In terms of outcomes, 82% (41/50) recorded good-to-excellent OSIS scores (84% (26/31) physiotherapy, 79% (15/19) surgery), and 76% (38/50) reported low pain VAS scores at final follow-up. Complications of the total surgical cohort included a 19% (5/27) revision rate, 11% (3/27) frozen shoulder, and 4% (1/27) scar sensitivity. CONCLUSION This is the largest midterm series reporting chronic anterior SCJ instability outcomes when managed according to a standardized treatment algorithm that emphasizes the importance of appropriate patient selection for either physiotherapy or surgery, based on a history of trauma. All but two patients achieved a stable SCJ, with stability maintained at a median of 70 months (11 to 116) for the physiotherapy group and 87 months (6 to 144) for the surgery group.Cite this article: Bone Jt Open 2022;3(10):815-825.
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Affiliation(s)
- Lambros Athanatos
- Leicester Shoulder Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | | | - Harvinder P. Singh
- Leicester Shoulder Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Alison L. Armstrong
- Leicester Shoulder Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
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17
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Operative Therapie der chronischen Instabilität des Sternoklavikulargelenks. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00550-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Successful Nonsurgical Management of a Posteriorly Displaced Medial Clavicular Physeal Fracture in an Adolescent Athlete: A Case Report. Clin J Sport Med 2022; 32:e319-e321. [PMID: 33914493 DOI: 10.1097/jsm.0000000000000878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/23/2020] [Indexed: 02/02/2023]
Abstract
Traumatic and sport-related sternoclavicular (SCJ) injuries in adolescent athletes are more commonly physeal fractures rather than true SCJ dislocations. Although rare, posterior displacement of the medial clavicular metaphysis after a physeal fracture necessitates prompt evaluation and treatment. Despite the inherent healing ability of physeal separations, delayed or failed diagnosis has the capacity to cause serious complications or fatality secondary to injury of retrosternal structures. Even with the potential severity, a lack of consensus exists in the literature regarding the most appropriate treatment modality. We report an adolescent football player with a medial clavicular physeal fracture with posterior metaphyseal displacement abutting the left brachiocephalic vein. After nonsurgical management and progression to play, the patient returned to play football. This case not only highlights the diagnostic principles of medial clavicular physeal fractures with posterior metaphyseal displacement but also discusses how these challenging injuries can be managed successfully with conservative treatment.
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19
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Qu Y, Xie X, Zhou W, Xia T, Cao F, Mi B, Xiong Y, Ye Z, Liu G. Operative treatment outcomes of anterior sternoclavicular joint dislocation using two experimental methods - an acromioclavicular joint hook plate versus a locking plate: a retrospective study. BMC Musculoskelet Disord 2022; 23:350. [PMID: 35410232 PMCID: PMC8996669 DOI: 10.1186/s12891-022-05293-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/14/2022] [Indexed: 09/07/2024] Open
Abstract
Background We aimed to compare the intraoperative and early postoperative clinical outcomes of using an acromioclavicular joint hook plate (AJHP) versus a locking plate (LP) in the treatment of anterior sternoclavicular joint dislocation. Methods Seventeen patients with anterior sternoclavicular joint dislocation were retrospectively analyzed from May 2014 to September 2019. Six patients were surgically treated with an AJHP, and 11 were surgically treated with an LP. Five male and one female patients composed the AJHP group, and nine male and two female patients composed the LP group. The mean age of all patients was 49.5 years. Results Reduction and fixation were performed with AJHP or LP in all 17 patients. The mean operative blood loss, operative time, and length of incision in the AJHP group were significantly better than those in the LP group. Shoulder girdle movement of the AJHP group was significantly better than that of the LP group. Conclusions This study revealed that AJHP facilitated glenohumeral joint motion, reduced the risk of rupture of mediastinal structures, required a shorter incision, and had lesser blood loss and a shorter duration of operation compared with LP. However, some deficiencies require further improvement. Supplementary information The online version contains supplementary material available at 10.1186/s12891-022-05293-x.
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Affiliation(s)
- Yanzhen Qu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Xudong Xie
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Wu Zhou
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Tian Xia
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Faqi Cao
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Bobin Mi
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Yuan Xiong
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Zhewei Ye
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China
| | - Guohui Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, People's Republic of China.
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20
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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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21
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Fandridis E, Koutserimpas C, Raptis K, Antonopoulos D, Zampeli F, Gakidis I. Anterior dislocation of sternoclavicular joint: A novel surgical technique. Injury 2022; 53:1562-1567. [PMID: 34740440 DOI: 10.1016/j.injury.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Anterior sternoclavicular joint dislocation (SCJ) is a relative rare injury, related to high energy trauma. The objective of the present study is to present a novel suture technique for treatment of anterior SCJ traumatic dislocation and to report clinical outcomes from a small case series undergoing this procedure. PATIENTS AND METHODS Patients presenting with traumatic anterior SCJ disruption in our institution were eligible to participate. Surgical technique consisted of two bone tunnels drilled in vertical direction from the anterior to the posterior cortex of the manubrium. Analogous to the sternal side of the clavicle, two vertical bone tunnels were drilled from the anterior cortex towards the posterior cortex. A non-absorbable suture was passed though the four holes in a parallel configuration. Then, by pulling the free suture edges the posterior translation of the clavicle was performed. Two additional drill holes, the first in manubrium and the second in clavicle were performed from the anterior cortex to the posterior between the previous bone tunnels. A non-absorbable suture was placed in a simple configuration in order to stabilize the SCJ in the superior-inferior direction. The final follow up was 28.2 months. The mean QuickDASH was used for functional assessment. RESULTS Seven patients (6 males and 1 female) with average age of 34,8 years were included in the present study. Two patients suffered from concomitant medial clavicle fracture. At final follow-up (none of the patients had experienced any symptoms of instability of SCJ, no side-to-side difference was observed, while the Mean QuickDASH score was 4.85. CONCLUSION The reported technique for SCJ reconstruction in traumatic anterior SCJ dislocations with two sutures has theoretical advantages, since it stabilizes the SCJ in the antero-posterior, as well as the supero- inferior direction. Outcomes from this small case series are favorable. However, more research is desirable to compare different techniques and to conclude to the optimal surgical treatment.
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Affiliation(s)
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Greece.
| | - Konstantinos Raptis
- Hand-Upper Limb & Microsurgery Department, Hospital "KAT", Athens, Greece; Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Greece
| | | | - Frantzeska Zampeli
- Hand-Upper Limb & Microsurgery Department, Hospital "KAT", Athens, Greece
| | - Ioannis Gakidis
- Department of Thoracic Surgery, Hospital "KAT", Athens, Greece
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22
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Obremskey WT, Rodriguez-Baron EB, Tatman LM, Pesantez RF. Acute Dislocations of the Sternoclavicular Joint: A Review Article. J Am Acad Orthop Surg 2022; 30:148-154. [PMID: 34898528 DOI: 10.5435/jaaos-d-20-01239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 11/01/2021] [Indexed: 02/01/2023] Open
Abstract
Acute dislocations of the sternoclavicular joint are uncommon injuries, and it is difficult for physicians to develop expertise in treating these injuries because of their infrequent nature. No level I evidence currently exists for these injuries, but several retrospective studies and surgical techniques have been described. For acute injuries, current recommendations include early treatment with closed reduction. If unable to attain or maintain reduction after a closed attempt, open management should be considered. Previous reviews have outlined relevant anatomy, physical examination findings, and imaging for these injuries. This article aims to review updated information from the past decade regarding techniques for reduction, outcomes, and complications related to the injury and surgical management.
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Affiliation(s)
- William T Obremskey
- From the Division of Orthopaedic Trauma, Vanderbilt University Medical center (Obremskey and Baron), Division of Orthopaedic Trauma, Fundacion Santa Fe de Bogota University Hospital, Bogotá D.C., Colombia (Pesantez); Division of Orthopaedic Trauma, Washington University, St. Louis, MO (Tatman)
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23
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Karan CL, Ravish VN, Channappa TS, Raju GB, Jayaram M. Traumatic sternoclavicular joint dislocation - A case series and discussion of methods of management. JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2022. [DOI: 10.4103/jodp.jodp_35_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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24
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Chen X, Shafer D, Neeki AS, Dong F, Matiko J, Neeki MM. Emergent Management of Traumatic Posterior Sternoclavicular Joint Dislocation: A Case Report and Literature Review. Cureus 2021; 13:e18996. [PMID: 34853739 PMCID: PMC8608401 DOI: 10.7759/cureus.18996] [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] [Accepted: 10/23/2021] [Indexed: 11/11/2022] Open
Abstract
Sternoclavicular joint (SCJ) dislocation is a rare but serious orthopedic injury. Posterior dislocations are more concerning due to the SCJ’s proximity to visceral structures such as the trachea, esophagus, subclavian vessels, and brachial plexus. Due to the potential long-term sequelae of missed diagnosis, clinical suspicion should be high when a patient presents with a compression-type injury to the shoulder girdle and pain or deformity to the SCJ. Here we present a case of a 15-year-old soccer player who presented to the emergency department (ED) after a fall onto his right shoulder with additional compound injuries. A posterior SCJ dislocation diagnosis was suspected and confirmed after a computed tomography scan. A successful closed reduction was done in the ED after consultation with cardiothoracic and orthopedic surgery. This case adds to the body of literature describing diagnosis and management of posterior SCJ dislocations.
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Affiliation(s)
- Xi Chen
- Emergency Medicine, California University of Science and Medicine, Colton, USA
| | - Dylan Shafer
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, USA
| | - Arianna S Neeki
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Fanglong Dong
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA.,Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, USA
| | - James Matiko
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA.,Emergency Medicine, California University of Science and Medicine, Colton, USA
| | - Michael M Neeki
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA.,Emergency Medicine, California University of Science and Medicine, Colton, USA
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25
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Min KS, Lopez A, Powlan FJ, Pham B, Lause G. Ultrasound-guided sternoclavicular joint injection: technique and case series. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:393-397. [PMID: 37588724 PMCID: PMC10426650 DOI: 10.1016/j.xrrt.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Sternoclavicular joint pathology can be an uncommon cause of pain and discomfort around the neck and shoulder region. Typically, patients localize their pain deep to the joint and experience referred pain to the ipsilateral neck and shoulder; however, it often presents as a diffuse nonspecific pain. Given the paucity of this pathology and atypical presentation, the use of injections can be helpful to confirm the diagnosis of sternoclavicular arthropathy. Currently, most injections are done via computed tomography. Although this method is accurate, it exposes patients to radiation and burdens the patient with the requirement of multiple appointments. This case series outlines the use of ultrasound-guided sternoclavicular joint injections conducted in the clinic. The patients in this series underwent an ultrasound-guided injection in the affected sternoclavicular joint, which confirmed the diagnosis, and they were subsequently treated with resection arthroplasty. The use of ultrasound-guided injections of the sternoclavicular joint is a safe and accurate alternative diagnostic method, which saves the patient from harmful radiation and additional appointments. Limitations and efficacy may vary depending on skill and comfort level of the operator.
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Affiliation(s)
- Kyong S. Min
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Andrew Lopez
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Franklin J. Powlan
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Brandon Pham
- Michigan State University College of Osteopathic Medicine, Est Lansing, MI, USA
| | - Greg Lause
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
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26
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Repair of sternoclavicular joint ligament: a novel approach. Ir J Med Sci 2021; 191:2141-2145. [PMID: 34719778 DOI: 10.1007/s11845-021-02826-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Posterior sternoclavicular dislocations are common in younger patients and are frequently due to high energy sporting incidents. AIM We aim to demonstrate a novel technique that is safe and aims to provide good functional post-operative outcomes for patients with this injury. METHODS This was a single-surgeon case series of four young patients from October 2017 to July 2019. The operative technique involved relocating the joint and holding it in situ with nylon suture tape. The tape was anchored in holes drilled in the sternum and passed through tunnels drilled into the medial clavicle. All of the patients were contacted retrospectively and a Nottingham Clavicle Score (NCS) was performed for each patient on a post-operative basis. RESULTS No intra-operative or post-operative complications were noted. All of the patients demonstrated a significant improvement in their functional outcomes after the operation. The average NCS for the four patients was 82/100. DISCUSSION There are a variety of techniques described in the literature to repair this ligament using either plates or tendon grafts. All of these techniques describe the drilling of anteroposterior holes in the manubrium and clavicle which run the intra-operative risk of perforating a major vessel. This paper is the first one to describe a technique which uses superior inferior holes which minimizes the risks, making the procedure safer for the patient. CONCLUSIONS We believe this novel technique is safer than the existing described techniques, and it does not compromise on functional outcomes.
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27
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The emergency medicine management of clavicle fractures. Am J Emerg Med 2021; 49:315-325. [PMID: 34217972 DOI: 10.1016/j.ajem.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Clavicle fractures are common. An emergency physician needs to understand the diagnostic classifications of clavicle fractures, have a plan for immobilization, identify associated injuries, understand the difference between treating pediatric and adult patients, and have an approach to multimodal pain control. It is also important to understand when expert orthopedic consultation or referral is indicated. OBJECTIVE OF THE REVIEW To provide an evidence-based review of clavicle fracture management in the emergency department. DISCUSSION Clavicle fractures account for up to 4% of all fractures evaluated in the emergency department. They can be separated into midshaft, distal, and proximal fractures. They are also classified in terms of their degree of displacement, comminution and shortening. Emergent referral is indicated for open fractures, posteriorly displaced proximal fractures, and those with emergent associated injuries. Urgent referral is warranted for fractures with greater than 100% displacement, fractures with >2 cm of shortening, comminuted fractures, unstable distal fractures, and floating shoulder. Nondisplaced or minimally displaced fractures with no instability or associated neurovascular injury are managed non-operatively with a sling. Pediatric fractures are generally managed conservatively, with adolescents older than 9 years-old for girls and 12 years-old for boys being treated using algorithms that are similar to adults. CONCLUSIONS When encountering a patient with a clavicle fracture in the emergency department the fracture pattern will help determine whether emergent consultation or urgent referral is indicated. Most patients can be discharged safely with sling immobilization and appropriate outpatient follow-up.
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28
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Calderazzi F, Menozzi M, Valenti P, Colacicco A, Bastia P, Pogliacomi F, Ceccarelli F. A rare case of complicated pure posterior sternoclavicular dislocation in a young athlete. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020015. [PMID: 33559637 PMCID: PMC7944707 DOI: 10.23750/abm.v91i14-s.10949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/24/2022]
Abstract
Sternoclavicular joint dislocation (SCJD) is a rare injury, generally classified in anterior and posterior. The posterior SCJD is very infrequent yet potentially associated with life-threatening complications. In patients with unfused medial clavicle physis, SCJD can be associated with fracture-dislocation (Salter type I or II). We hereby present the case of a 12-year-old basketball player with severe pain in sternoclavicular region and arising dysphagia after a fall and tackle by another player. A SCJ injury was hypothesised and the CT scan detected the presence of a true posterior SCJD with no associated fracture, which was also confirmed during open reduction. As the patient complained dysphagia, it was also necessary to study other possible mediastinal compressions by a contrast medium CT scan of the great vessels. The CT scanned brachiocephalic vein compression without additional clinical evidence or signs. Twenty hours after the trauma the patient underwent an unsuccessful closed reduction; for this reason, surgical treatment with open reduction and fixation was mandatory. After 12 weeks of therapy she returned to her previous sport activity. (www.actabiomedica)
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Affiliation(s)
- Filippo Calderazzi
- Dipartimento Scienze Chirurgiche Ospedale Maggiore Parma, U.O. Clinica Ortopedica.
| | - Margherita Menozzi
- a) Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, Via Gramsci 14,43100 Parma, Italy.
| | - Piergiulio Valenti
- a) Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, Via Gramsci 14,43100 Parma, Italy.
| | - Alessandra Colacicco
- a) Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, Via Gramsci 14,43100 Parma, Italy.
| | - Paolo Bastia
- a) Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, Via Gramsci 14,43100 Parma, Italy.
| | - Francesco Pogliacomi
- a) Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, Via Gramsci 14,43100 Parma, Italy.
| | - Francesco Ceccarelli
- a) Department of Medicine and Surgery, Orthopaedic Clinic, Parma University Hospital, Via Gramsci 14,43100 Parma, Italy.
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ÇAKMAK V, TÜRKOĞLU S, ÖZEN M, ÇAKMAK P. Künt göğüs travmasında sternoklaviküler eklem mesafelerinin genişlemesi. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.779481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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30
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Bakir MS, Lefering R, Haralambiev L, Kim S, Ekkernkamp A, Gümbel D, Schulz-Drost S. Acromioclavicular and sternoclavicular joint dislocations indicate severe concomitant thoracic and upper extremity injuries in severely injured patients. Sci Rep 2020; 10:21606. [PMID: 33303859 PMCID: PMC7730423 DOI: 10.1038/s41598-020-78754-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/26/2020] [Indexed: 11/09/2022] Open
Abstract
Preliminary studies show that clavicle fractures (CF) are known as an indicator in the severely injured for overall injury severity that are associated with relevant concomitant injuries in the thorax and upper extremity. In this regard, little data is available for the rarer injuries of the sternoclavicular and acromioclavicular joints (SCJ and ACJ, respectively). Our study will answer whether clavicular joint injuries (CJI), by analogy, have a similar relevance for the severely injured. We performed an analysis from the TraumaRegister DGU (TR-DGU). The inclusion criterion was an Injury Severity Score (ISS) of at least 16. In the TR-DGU, the CJI were registered as one entity. The CJI group was compared with the CF and control groups (those without any clavicular injuries). Concomitant injuries were distinguished using the Abbreviated Injury Scale according to their severity. The inclusion criteria were met by n = 114,595 patients. In the case of CJI, n = 1228 patients (1.1%) were found to be less severely injured than the controls in terms of overall injury severity. Compared to the CF group (n = 12,030; 10.5%) with higher ISS than the controls, CJI cannot be assumed as an indicator for a more severe trauma; however, CF can. Concomitant injuries were more common for severe thoracic and moderate upper extremity injuries than other body parts for CJI. This finding confirms our hypothesis that CJI could be an indicator of further specific severe concomitant injuries. Despite the rather lower relevance of the CJI in the cohort of severely injured with regard to the overall injury severity, these injuries have their importance in relation to the indicator effect for thoracic concomitant injuries and concomitant injuries of the upper extremity. A limitation is the collective registration of SCJ and ACJ injuries as one entity in the TR-DGU. A distorted picture of the CJI in favor of ACJ injuries could arise from the significantly higher incidence of the ACJ dislocation compared to the SCJ. Therefore, these two injury entities should be recorded separately in the future, and prospective studies should be carried out in order to derive a standardized treatment strategy for the care of severely injured with the respective CJI.
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Affiliation(s)
- M Sinan Bakir
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany. .,Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683, Berlin, Germany.
| | - Rolf Lefering
- Faculty of Health, IFOM - Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str.200, Haus 38, 51109, Cologne, Germany
| | - Lyubomir Haralambiev
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.,Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683, Berlin, Germany
| | - Simon Kim
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Axel Ekkernkamp
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.,Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683, Berlin, Germany
| | - Denis Gümbel
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.,Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683, Berlin, Germany
| | - Stefan Schulz-Drost
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683, Berlin, Germany.,Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany.,Department of Trauma Surgery, Helios Hospital Schwerin, Wismarsche Str. 393-397, 19049, Schwerin, Germany
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Kane SM, Morris DV, Badana ANS. A Transarticular Approach to Posterior Sternoclavicular Dislocation: A Case Report. HSS J 2020; 16:490-497. [PMID: 33380985 PMCID: PMC7749927 DOI: 10.1007/s11420-020-09772-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Steven M. Kane
- Department of Orthopedics, Wellstar Atlanta Medical Center, Atlanta, GA USA
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Feng W, Cai X, Li S, Li Z, Zhang K, Wang H, Zhang J, Zhu Y, Feng D. Balser Plate Stabilization for Traumatic Sternoclavicular Instabilities or Medial Clavicle Fractures: A Case Series and Literature Review. Orthop Surg 2020; 12:1627-1634. [PMID: 32893491 PMCID: PMC7767773 DOI: 10.1111/os.12726] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE This study was performed to observe the effect of internal Balser plate fixation for treating unstable sternoclavicular joints (SCJ) and displaced medial clavicle fractures. METHODS From April 2009 to September 2016, 17 consecutive patients who underwent open reduction and internal Balser plate fixation for SCJ dislocations or medial clavicle fractures were retrospectively reviewed. There were 11 male and six female patients, with a mean age of 45.6 ± 15.5 years. Standardized treatment procedures consisted of reduction, creating a space posterior dorsal osteal face of the sternal manubrium, an inverted Balser plating, and postoperative immobilization. At follow-up, plain radiographs were assessed for fracture union, implant loosening, degenerative changes, and joint congruity. Clinical evaluation included: completion of the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire; determination of the Constant and Murley score and visual analog scale (VAS) score; and assessment of intraoperative and postoperative complications. RESULTS All patients were followed up, at a mean follow-up of 20.1 ± 7.9 months, each fracture had a solid union, and each dislocation showed no sign of recurrent dislocation. The mean shoulder forward flexion was 162.9° ± 8.1°. The mean DASH score was 5.2 ± 5.2 points. The mean Constant and Murley joint function score was 93.7 ± 7.9 points, with 15 excellent cases and two good cases. The mean VAS score was 1.1 ± 1.4 points, showing significant improvement compared with the VAS score preoperatively. Postoperative complications included one wound hematoma which was healed after a debridement and one recurrent instability due to hook migration, which underwent revision reconstruction. All patients were satisfied with their treatment outcome at the final follow-up. CONCLUSION Sternoclavicular joints dislocation or medial clavicle fractures can be treated successfully with Balser plate fixation. This technique permits early functional exercise while preserving the SCJ.
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Affiliation(s)
- Wei‐lou Feng
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Xiao Cai
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Shu‐hao Li
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Zi‐jun Li
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Kun Zhang
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Hao Wang
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Jun Zhang
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Yang‐jun Zhu
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
| | - Dong‐xu Feng
- Department of Orthopaedic TraumaHong Hui Hospital, Xi’an Jiaotong University School of MedicineXi’anChina
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Dey Hazra RO, Reich AR, Hanhoff M, Warnhoff M, Lill H, Jensen G. [Injuries of the sternoclavicular joint]. Unfallchirurg 2020; 123:879-889. [PMID: 33048209 DOI: 10.1007/s00113-020-00888-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Injuries of the sternoclavicular joint (SCJ) are rare accounting for 3% of all injuries to the shoulder girdle and are often overlooked. The SCJ is surrounded by tight ligamentous structures, thus substantial energy with corresponding force vectors is needed to cause dislocation. Causative are mostly high-energy traumas. Anterior dislocation is most common but in rare cases potentially life-threatening posterior dislocation occurs, which requires immediate reduction. The established gold standard is 3D reconstruction in contrast-enhanced computed tomography (CT) for depiction of neurovascular structures. Low-grade instability can initially be treated conservatively. For unsuccessful attempts at reduction, high-grade instability and chronic instability various surgical techniques are established. Next to retentive augmentation with suture materials, in acute cases with chronic instability biological tendon augmentation is preferred. In cases of posttraumatic instability arthritis SCJ resection with or without additive biological augmentation can be carried out. Various study groups have shown good to very good midterm outcome.
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Affiliation(s)
- Rony-Orijit Dey Hazra
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift Hannover, Humboldstr. 5, 30169, Hannover, Deutschland.
| | - Anne-Rieke Reich
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift Hannover, Humboldstr. 5, 30169, Hannover, Deutschland
| | - Marek Hanhoff
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift Hannover, Humboldstr. 5, 30169, Hannover, Deutschland
| | - Mara Warnhoff
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift Hannover, Humboldstr. 5, 30169, Hannover, Deutschland
| | - Helmut Lill
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift Hannover, Humboldstr. 5, 30169, Hannover, Deutschland
| | - Gunnar Jensen
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift Hannover, Humboldstr. 5, 30169, Hannover, Deutschland
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Garcia JA, Arguello AM, Momaya AM, Ponce BA. Sternoclavicular Joint Instability: Symptoms, Diagnosis And Management. Orthop Res Rev 2020; 12:75-87. [PMID: 32801951 PMCID: PMC7395708 DOI: 10.2147/orr.s170964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/13/2020] [Indexed: 12/24/2022] Open
Abstract
Sternoclavicular joint (SCJ) instability is a rare condition and results from either a traumatic high energy impact, such as a motor vehicle crash or contact sports injury, or non-traumatically as a result of structural pathology. The infrequency of this injury has contributed to its diagnosis being missed as well as the paucity of literature on treatment and outcomes. Patients with SCJ instability often report diminished range of motion as well as shoulder girdle pain. The presentation of instability in the sternoclavicular joint can vary in severity and anterior or posterior directionality. Variation in severity of the instability changes the course of treatment regarding either operative or non-operative interventions to stabilize the SCJ. In general, anterior instability of the SCJ (the medial clavicle is displaced anterior to the sternum) is less urgent and generally manageable by symptom alleviation and rehabilitation, although some anterior instability cases require surgical intervention. In the case of posterior SCJ instability (the medial clavicle is displaced posterior to the sternum), patients require prompt joint reduction as they are at the greater risk of life-threatening injury due to the location of critical structures of the mediastinum posterior to the SCJ. Computed tomography visualization is useful to confirm dislocation or subluxation direction to better formulate a proper treatment plan. The purpose of this review is to report the clinical presentation and management of SCJ instability including pertinent symptoms, the diagnostic approaches to evaluating SCJ instability, as well as operative and non-operative management of the joint instability.
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Affiliation(s)
- Jacob A Garcia
- University Of Alabama At Birmingham School Of Medicine, Birmingham, AL 35294, USA
| | - Alexandra M Arguello
- University Of Alabama At Birmingham, Department Of Orthopedic Surgery, Birmingham, AL 35294, USA
| | - Amit M Momaya
- University Of Alabama At Birmingham, Department Of Orthopedic Surgery, Birmingham, AL 35294, USA
| | - Brent A Ponce
- University Of Alabama At Birmingham, Department Of Orthopedic Surgery, Birmingham, AL 35294, USA
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35
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Kani KK. Clavicle Fractures: Review and Update for Radiologists. Curr Probl Diagn Radiol 2020; 49:199-204. [DOI: 10.1067/j.cpradiol.2019.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/07/2019] [Accepted: 02/20/2019] [Indexed: 11/22/2022]
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Imam MA, Javed S, Trail I, Monga P. The unicortical sternoclavicular joint reconstruction using synthetic graft. Shoulder Elbow 2020; 12:144-147. [PMID: 32313564 PMCID: PMC7153205 DOI: 10.1177/1758573218790964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/29/2018] [Indexed: 11/16/2022]
Abstract
Sternoclavicular joint injuries represent 5% of all injuries to the shoulder complex. We report a safe and reproducible technique for reconstruction of anterior sternoclavicular joint dislocations, employing a synthetic graft using a unicortical technique with minimal dissection anterior to the joint.
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Affiliation(s)
- Mohamed A Imam
- Upper Limb Research Unit, The Upper Limb Unit, Wrightington Hospital, Wigan, UK,Trauma and Orthopaedics, Norfolk and Norwich University Hospitals NHS Foundation, Norwich, UK,Mohamed A Imam, Upper Limb Research Unit, The Upper Limb Unit, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan WN6 9EP, UK.
| | - Saqib Javed
- Upper Limb Research Unit, The Upper Limb Unit, Wrightington Hospital, Wigan, UK
| | - Ian Trail
- Upper Limb Research Unit, The Upper Limb Unit, Wrightington Hospital, Wigan, UK
| | - Puneet Monga
- Upper Limb Research Unit, The Upper Limb Unit, Wrightington Hospital, Wigan, UK
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37
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Moreels R, De Wilde L, Van Tongel A. Evolution of nonoperative treatment of atraumatic sternoclavicular dislocation. J Shoulder Elbow Surg 2019; 28:2350-2355. [PMID: 31350108 DOI: 10.1016/j.jse.2019.04.060] [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: 12/02/2018] [Revised: 04/17/2019] [Accepted: 04/24/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Atraumatic sternoclavicular dislocation (ASCD) is an uncommon pathology that is mainly diagnosed in young adults. The aim of this study is to better describe the clinical picture of ASCD and to describe the results of a "wait-and-see" policy in these patients. METHODS All patients with ASCD who visited our department between 2011 and 2016 were retrospectively analyzed. A standardized clinical examination was used to evaluate the clinical picture. All patients were treated nonoperatively, and at latest follow-up, several parameters and standardized questionnaires (Nottingham Clavicle Score, Oxford Shoulder Score, Constant-Murley Score) were used to evaluate the outcome. RESULTS In total, 23 patients (12 male, 11 female) were evaluated. The average age at diagnosis was 18.6 years. There was a significant difference (P < .001) in angle of dislocation during forward flexion (mean = 141°) compared with abduction (mean = 101°). At latest follow-up (average 46 months, range 14-113 months; standard deviation [SD] = 27), subluxations still occurred but were less frequent and less prominent relative to presentation at initial diagnosis in 19 of 23 patients. The chance of subjective improvement increased by 27% for each year of follow-up. High outcome scores of Nottingham Clavicle Score (mean score = 80, SD = 11), Oxford Shoulder Score (mean score = 44, SD = 4), and Constant-Murley Score (mean score = 83, SD = 11) were reported. CONCLUSION In patients with ASCD, the clavicle subluxates earlier in abduction than in forward flexion. After a midterm follow-up, a "wait-and-see" policy does not resolve the subluxations. However, most patients displayed reduced frequency and severity of subluxations over their recovery period and showed excellent scores on shoulder questionnaires.
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Affiliation(s)
- Robin Moreels
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium.
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Kendal JK, Thomas K, Lo IKY, Bois AJ. Clinical Outcomes and Complications Following Surgical Management of Traumatic Posterior Sternoclavicular Joint Dislocations: A Systematic Review. JBJS Rev 2019; 6:e2. [PMID: 30399119 DOI: 10.2106/jbjs.rvw.17.00157] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Traumatic posterior sternoclavicular joint dislocations are rare orthopaedic emergencies. Treatment typically consists of closed reduction, with surgical management reserved for unstable cases. Because of the low prevalence of this condition, limited clinical evidence exists for a superior surgical stabilization technique. METHODS A systematic review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. MEDLINE and Embase databases were searched using a comprehensive search strategy. A descriptive and critical analysis of the results was performed. RESULTS Forty relevant studies (108 cases) were identified. Favorable subjective and objective outcomes were reported for all 5 categories of stabilization described. The overall complication rate was 16%, including 4 cases of recurrent instability. Ligament reconstruction using tendon graft had the lowest recurrent instability and complication rates, and open reduction and internal fixation techniques required a second operation for implant removal in 80% of cases. CONCLUSIONS A comprehensive review of the surgical management of traumatic posterior sternoclavicular joint dislocations is presented. Results suggest favorable outcomes for all of the methods of stabilization, with a modest complication rate. The trends observed have helped to guide the development of clinical care recommendations that aid in treatment decision-making for these injuries. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Joseph K Kendal
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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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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Wang H, Wang C, Ruan J, Wu W. Asymmetrical bilateral sternoclavicular joint dislocation combined with bilateral clavicular fracture: A case report. Medicine (Baltimore) 2019; 98:e16359. [PMID: 31305431 PMCID: PMC6641823 DOI: 10.1097/md.0000000000016359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Asymmetrical bilateral sternoclavicular joint (SCJ) dislocation consists of posterior SCJ dislocation on one side and anterior SCJ dislocation on the other side. This is an extremely rare injury and only a few cases have been reported in the literature. If not been diagnosed timely and accurately, asymmetrical bilateral SCJ dislocation can be life-threatening. PATIENTS CONCERNS We experienced a patient who has a life-threatening posterior dislocation of right SCJ and anterior dislocation on the left SCJ combined with bilateral clavicular fracture after a traffic accident. DIAGNOSES A computed tomography (CT) scan with three-dimensional reconstructions of SCJ showed potentially life-threatening posterior dislocation of right SCJ and anterior dislocation on the left SCJ combined with bilateral clavicular fracture. INTERVENTIONS Because of failed attempts at closed reduction, electively surgical intervention was made. We repaired the ruptured joint capsule and ligaments and fixed bilateral SCJ by Kirschner wire during the operation. OUTCOMES Three-dimensional CT scans confirmed bilateral SCJ reduction and alignment after operation 1 week as well as at the 2-month follow-up. LESSONS SCJ dislocation is an extremely rare and life-threatening injury. The aim of the operation is to repair the ruptured joint capsule and its ligaments and to fix the dislocated joints.
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Affiliation(s)
| | - Chongyang Wang
- Department of Respiration, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
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Miyamoto S, Otsuka M, Hasue F, Fujiyoshi T, Kamiya K, Kiuchi H, Tanaka T, Nakamura J, Orita S, Ohtori S. Stress fracture of the midshaft clavicle associated with sternocostoclavicular hyperostosis-Case report. Int J Surg Case Rep 2019; 58:121-126. [PMID: 31035227 PMCID: PMC6488687 DOI: 10.1016/j.ijscr.2019.03.059] [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] [Received: 02/06/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 12/12/2022] Open
Abstract
Stress fractures of the midshaft of the clavicle caused by sternocostoclavicular hyperostosis are very rare. The differential diagnosis of sternocostoclavicular hyperostosis might be difficult. Sternocostoclavicular hyperostosis in the patient was suspected of having either SAPHO syndrome or ankylosing spondylitis. The patient was treated conservatively and the shoulder function was satisfactory at the final follow-up.
Introduction Stress fracture is generally a result of cumulative and repetitive stress in athletes, which accelerates the normal remodeling process of bones, and the most frequently involved areas are the tibia and metatarsal bones. Therefore, stress fractures of the midshaft of the clavicle are very rare. Presentation of case A 58-year-old female was admitted to our hospital because of pain in the middle of the right clavicle. Based on laboratory and radiographic inspection, it was concluded that the stress fracture of the midshaft of the clavicle in this case was caused by sternocostoclavicular hyperostosis (SCCH). Because the clavicular fracture had no displacement or callus formation, conservative treatment with a clavicle band was undertaken. Shoulder function at the final follow-up visit was satisfactory. Discussion SCCH is a rare chronic inflammatory disorder of the axial skeleton and ossifying diathesis associated with a predominantly osteogenic response. Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome and ankylosing spondylitis (AS) should be considered in the differential diagnosis of SCCH. If a patient with this type of fracture has no history of traumatic injury or sports activity, the differential diagnosis might be very difficult. Conclusion We report the case of a female who had a stress fracture of the midshaft of the clavicle associated with SCCH in SAPHO or AS. Although the patient was treated conservatively, and the shoulder function was satisfactory at the final follow-up visit, re-fracture may occur in the future.
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Affiliation(s)
- Shuichi Miyamoto
- Kimitsu Central Hospital, 1010 Sakurai, Kisarazu City, Chiba, 292-8535, Japan.
| | - Makoto Otsuka
- Kimitsu Central Hospital, 1010 Sakurai, Kisarazu City, Chiba, 292-8535, Japan.
| | - Fumio Hasue
- Kimitsu Central Hospital, 1010 Sakurai, Kisarazu City, Chiba, 292-8535, Japan.
| | - Takayuki Fujiyoshi
- Kimitsu Central Hospital, 1010 Sakurai, Kisarazu City, Chiba, 292-8535, Japan.
| | - Koushirou Kamiya
- Kimitsu Central Hospital, 1010 Sakurai, Kisarazu City, Chiba, 292-8535, Japan.
| | - Hitoshi Kiuchi
- Kimitsu Central Hospital, 1010 Sakurai, Kisarazu City, Chiba, 292-8535, Japan.
| | - Tadashi Tanaka
- Kimitsu Central Hospital, 1010 Sakurai, Kisarazu City, Chiba, 292-8535, Japan.
| | - Junichi Nakamura
- Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan.
| | - Sumihisa Orita
- Center for Advanced Joint Function and Reconstructive Spine Surgery Graduate school of Medicine, Chiba University 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Seiji Ohtori
- Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan.
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Digital tomography is an effective investigation for sternoclavicular joint pathology. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1217-1221. [PMID: 30963323 DOI: 10.1007/s00590-019-02433-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Plain radiographs of the sternoclavicular joint (SCJ) are difficult to interpret, and a CT or MRI scan is the usual investigation of choice. At our hospital, we use digital SCJ tomograms as our first-line investigation for all SCJ pathologies. We wanted to ascertain whether this is a safe and appropriate first-line imaging investigation. MATERIALS AND METHODS We retrospectively reviewed every patient who had undergone an SCJ digital tomogram (DT) over a 4-year period. We cross-referenced each patient with their records to assess the reason for referral, result, requirement for further investigation, diagnosis and management. RESULTS We identified 132 SCJ tomograms over the study period. Twelve patients were referred from other hospitals with pre-existing imaging and were excluded. The reasons for radiological investigation in the remaining 120 patients were pain/lump without trauma (54.2%), pain/lump with trauma (30.8%) and post-operative review (15%). Of the 102 patients who had DT as their initial investigation, the most common diagnoses identified included osteoarthritis, normal SCJ, fracture and dislocation among others. Only 18 (17.6%) of these patients required further investigation with CT and/or MRI. CONCLUSION Our study is the first to assess digital tomography in SCJ pathology. We have shown that digital tomograms are an accurate and economically beneficial investigation for SCJ pathology and propose that it should be used as a first-line imaging investigation.
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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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Goh YP, Kamali Moaveni A, Hoy G, Tate J, Rotstein A. Dynamic assessment of sternoclavicular joint instability using four‐dimensional computed tomography. J Med Imaging Radiat Oncol 2019; 63:216-221. [DOI: 10.1111/1754-9485.12862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 01/15/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Yin Peng Goh
- Victoria House Medical Imaging MIA Radiology I‐MED Radiology Network Melbourne Victoria Australia
| | - Ash Kamali Moaveni
- Department of surgery Alfred Hospital Monash University Melbourne Victoria Australia
| | - Gregory Hoy
- Melbourne Orthopaedic Group Melbourne Victoria Australia
- Department of Surgery Monash University Melbourne Victoria Australia
| | - Julie Tate
- Victoria House Medical Imaging MIA Radiology I‐MED Radiology Network Melbourne Victoria Australia
| | - Andrew Rotstein
- Victoria House Medical Imaging MIA Radiology I‐MED Radiology Network Melbourne Victoria Australia
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Qu YZ, Xia T, Liu GH, Zhou W, Mi BB, Liu J, Guo XD. Treatment of Anterior Sternoclavicular Joint Dislocation with Acromioclavicular Joint Hook Plate. Orthop Surg 2019; 11:91-96. [PMID: 30729708 PMCID: PMC6430452 DOI: 10.1111/os.12422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 11/11/2018] [Accepted: 12/13/2018] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of using acromioclavicular joint hook plates for the treatment of anterior sternoclavicular joint dislocation. METHODS Ten patients who suffered anterior sternoclavicular joint dislocation were retrospectively analyzed, and underwent acromioclavicular joint hook plate surgeries from January 2015 to May 2017. There were 7 male and 3 female patients, with a mean age of 43.6 years. According to the American Shoulder and Elbow Society (ASES) scoring system, the preoperative physical function had a mean of 83.5. RESULTS Reduction and fixation were performed with hook plates in all 10 patients. All patients were followed up, with a mean duration of 16.9 months. There were no complications, no wound infections, and no plate or screw breakages. Movement of the shoulder girdle was improved in all patients. According to the ASES scoring system, the postoperative physical function had a mean of 94.8. CONCLUSION The acromioclavicular joint hook plate demonstrates safety and efficacy for the treatment of anterior sternoclavicular joint dislocation. However, there are still some deficiencies that need to be improved.
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Affiliation(s)
- Yan-Zhen Qu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tian Xia
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guo-Hui Liu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wu Zhou
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo-Bin Mi
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Liu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Dong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Dhawan R, Singh RA, Tins B, Hay SM. Sternoclavicular joint. Shoulder Elbow 2018; 10:296-305. [PMID: 30214497 PMCID: PMC6134528 DOI: 10.1177/1758573218756880] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/14/2017] [Accepted: 12/31/2017] [Indexed: 12/16/2022]
Abstract
The sternoclavicular joint is a saddle shaped, synovial joint and is the only skeletal articulation between the axial skeleton and the upper limb. Here, a reviewis provided of the anatomy, biomechanics, traumatic and atraumatic conditions, and management options for the various conditions described.
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Affiliation(s)
- Rohit Dhawan
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, UK,Rohit Dhawan, Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, SY10 7AG, UK.
| | - Rohit Amol Singh
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, UK
| | - Bernhard Tins
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, UK
| | - Stuart M. Hay
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Gobowen, Oswestry, UK,Royal Shrewsbury Hospital, Shrewsbury, Shropshire, UK
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Edwin J, Ahmed S, Verma S, Tytherleigh-Strong G, Karuppaiah K, Sinha J. Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies. EFORT Open Rev 2018; 3:471-484. [PMID: 30237905 PMCID: PMC6134883 DOI: 10.1302/2058-5241.3.170078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The sternoclavicular joint (SCJ) is an integral part of the shoulder girdle that connects the upper limb to the axial skeleton. Swelling of the SCJ is commonly due to trauma, degeneration, infections and other disease processes that affect synovial joints. This review also focuses on uncommon conditions that could affect the SCJ, including SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome, Friedrich’s disease and Tietze syndrome. The scope of this review is limited to the analysis of the current evidence on the various conditions affecting the SCJ and also to provide an algorithm to manage these conditions.
Cite this article: EFORT Open Rev 2018;3:471-484. DOI: 10.1302/2058-5241.3.170078
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Affiliation(s)
| | - Shahbaz Ahmed
- Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK
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Tytherleigh-Strong G, Pecheva M, Titchener A. Treatment of First-Time Traumatic Anterior Dislocation of the Sternoclavicular Joint With Surgical Repair of the Anterior Capsule Augmented With Internal Bracing. Orthop J Sports Med 2018; 6:2325967118783717. [PMID: 30046630 PMCID: PMC6055321 DOI: 10.1177/2325967118783717] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Traumatic anterior dislocations of the sternoclavicular joint (SCJ) are rare. Although they can usually be treated by a closed reduction, the reported subsequent recurrence rate is 50%. Purpose To determine whether further instability after first-time traumatic anterior dislocation would be prevented by a minimally invasive open repair of the anterior SCJ capsule, augmented with internal bracing. Study Design Case series; Level of evidence, 4. Methods Open repair of the anterior SCJ capsule was completed on a series of patients who had sustained a first-time traumatic anterior dislocation of the SCJ. Patients with preexisting SCJ instability and recurrent dislocations were excluded. Through a transverse incision, the anterior SCJ capsule was repaired and plicated by use of sutures. The repair was then protected by use of an internal brace, bridging between the sternum and the medial end of the clavicle. Results Six patients (4 males, 2 females) with a mean age of 28.3 years were included. Four patients underwent surgery within 4 weeks of their dislocation, and 2 patients had ongoing symptoms of instability but had not had a further dislocation. The median follow-up was 28.2 months (range, 24-35 months). At the most recent follow-up, none of the patients had sustained further dislocation or episode of instability, and their SCJs appeared stable. The mean abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was 2.3 (range, 0-4.5). Conclusion The medium-term results of this case series suggest that after first-time dislocation, surgical repair of the anterior SCJ capsule augmented with internal bracing can prevent recurrent instability. This may be an attractive option for individuals involved in higher risk activities, as the operative management of recurrent anterior SCJ instability usually requires a figure-of-8 tendon reconstruction, which carries a significantly higher morbidity.
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Affiliation(s)
- Graham Tytherleigh-Strong
- Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals Trust, Cambridge, UK
| | - Mira Pecheva
- Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals Trust, Cambridge, UK
| | - Andrew Titchener
- Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals Trust, Cambridge, UK
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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: 1.2] [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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Frank RM, Bernardoni ED, Cotter EJ, Verma NN. Anatomic Acromioclavicular Joint Reconstruction With Semitendinosus Allograft: Surgical Technique. Arthrosc Tech 2017; 6:e1721-e1726. [PMID: 29399457 PMCID: PMC5793897 DOI: 10.1016/j.eats.2017.06.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/26/2017] [Indexed: 02/03/2023] Open
Abstract
Acromioclavicular joint separations are common shoulder injuries in the active patient population. Nonoperative management is recommended for Rockwood type I and II injuries, whereas surgical reconstruction is recommended for type IV and VI separations. The management for type III and V injuries is more controversial and is determined on a case-by-case basis. A multitude of surgical reconstruction techniques exist, and there is little evidence to support one technique over another. The anatomic technique aims at reconstructing the coracoclavicular ligaments and bringing the clavicle back into its anatomic position. When the anatomic technique is augmented with a graft, biomechanical studies have shown superior reconstruction strength and stability compared with standard nonanatomic techniques. Additionally, anatomic reconstruction allows for better cosmesis and functional outcome measures at midterm follow-up compared with nonanatomic techniques. In this Technical Note, we describe our preferred technique for anatomic repair of acromioclavicular joint separation using a semitendinosus allograft.
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Affiliation(s)
- Rachel M. Frank
- CU Sports Medicine, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, U.S.A.,Address correspondence to Rachel M. Frank, M.D., CU Sports Medicine, Department of Orthopedics, University of Colorado School of Medicine, 2150 Stadium Drive, Boulder, CO 80309, U.S.A.CU Sports MedicineDepartment of OrthopedicsUniversity of Colorado School of Medicine2150 Stadium DriveBoulderCO80309U.S.A.
| | - Eamon D. Bernardoni
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Eric J. Cotter
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N. Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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