Treatment of posterior sternoclavicular dislocation with locking plate osteosynthesis

Posterior dislocations of the sternoclavicular joint are rare injuries, representing approximately 3% of all major insults to the shoulder girdle. Despite their relative infrequency, they must be diagnosed and treated early because of the proximity of the sternoclavicular joint to sensitive anatomic structures in the superior mediastinum. Physical examination can yield limited findings, and a high index of suspicion is warranted for this injury pattern especially with impingement signs and symptoms: dyspnea, dysphagia, dysphonia, brachial plexus injury, and vascular alterations. Evaluation with plain anteroposterior radiographs is difficult because of superimposed ribs and lungs. A computed tomography scan is required for appropriate evaluation of this injury pattern. Once posterior dislocation of the sternoclavicular joint has been diagnosed, closed reduction should be attempted as soon as possible with a thoracic surgeon available. Most posterior sternoclavicular dislocations can be treated successfully with closed reduction and 6 to 8 weeks of immobilization. Recurrent dislocations or chronic dislocations require open treatment for stabilization. Precisely which technique should be used to obtain stable internal fixation is controversial, but ligament repair with reconstruction appears to be the most widely accepted. This article reports two such cases of recurrent dislocation that were treated with locking plate osteosynthesis as opposed to more commonly used soft tissue stabilization procedures. Both patients experienced a nearly full return to function and are currently doing well. A review of the current literature regarding this subject matter is also included.