[Traumatic manubriosternal joint dislocation in adult: about two surgical cases]

Traumatic manubriosternal joint dislocations are rare in adult and occur readily during a violent traumatism of the chest and/or the dorsal spine. We report two cases treated between September 1997 and August 2002 at the Surgical Emergency Department of Le Dantec Hospital. The first observation was related to a 26 year old lady. On September 27, 1997, she fell down from a tree and received all the weight of the body on her two arms. She was referred because of anterior chest pains, increasing with respiration associated with injuries of the 2 wrists. On conventional X-ray, a type II manubriosternal joint dislocation (anterior dislocation of the sternal body with respect to the manubrium) was diagnosed. The mechanism of the dislocation was indirect: flexion-compression of the sternum caused by a hyperflexion of the dorsal spine when the patient touched the ground. There was also a Pouteaux-Colles fracture of the 2 wrists. The dislocation was surgically treated: open reduction followed by manubriosternal stabilization using wires. The 2 wrists were treated by Kapandji procedure. At the 21st postoperative day, a traumatic rupture of the wires required a 2nd internal fixation of the sternum by wires. After 9 years, the patient is without complaint and the chest X-ray is normal. The second observation was that of a 19 year old young woman, referred on August 15, 2002 after a frontal crash with a car while crossing the road. She fell down on her back. She was complaining from severe posterior headaches with a normal Glasgow Scale (15), anterior chest and right hand pains. Radiological examinations showed a fracture of the occipital bone without embarrure and a type I manubriosternal joint dislocation (posterior displacement of the sternal body in relation to the manubrium) which mechanism was direct: direct shock against the sternum. There were also an isolated fracture of 4 right sided ribs and a fracture without displacement of the 3 last bones of the right metacarpus. An orthopaedic treatment was carried out for the lesions of the right hand and an abstention-monitoring suggested for the occipital fracture. The manubriosternal joint dislocation was surgically reduced and stabilized by using a braided polyester thread number 2. After 4 years, the patient is asymptomatic and the manobriosternal joint is stable. We emphasize on the scarcity and the mechanism of traumatic manubriosternal joint dislocations in adult, the frequency of associated injuries and the absence of consensus about their treatment.