[Diagnosis and therapy of sternoclavicular joint dislocation]

Luxation of the sternoclavicular joint is described on the basis of the case histories and progress of patients with this very rare form of injury who underwent surgical treatment on the Orthopedic Clinic of Düsseldorf University Hospital in the years 1978 to 1988. Four of the 6 patients in our study were subjected to a follow-up examination as out-patients. After preliminary remarks on the anatomical and biomechanical peculiarities of the sternoclavicular joint, the various types of luxation and the customary Allmann I-III classification for degree of severity are discussed. Surgical treatment is essential only for injuries of the IIIrd degree. Dislocation of the sternal end of the clavicle is most frequently found ventrad, as was also the case in all 6 patients in our study; the rarest finding is dorsad. The symptoms and the necessary diagnostic measures are described. Surgical treatment of the retrosternal luxation of the sternoclavicular joint is indicated as absolutely essential on account of the possibility of life-threatening complications. A relative indication of operative treatment exists for anterior luxation of the sternoclavicular joint where severe functional impairment and pain are present, e.g. during work and sport. The various operative methods currently in use are described. Reference is made to the importance of imaging techniques. A warning is given that, because of the risk of fatal complications, Kirschner wiring should not be used for retention of the reduction unless the K-wires are reliably secured.