Posterior remodeling of medial clavicle causing superior vena cava impingement

Injuries involving the sternoclavicular region resulting in posterior displacement of the medial clavicle are rare, and those that occur prior to fusion of the medial epiphyseal growth plate are more often a result of physis fracture, rather than sternoclavicular joint dislocation. Medial clavicular physis fractures initially are treated by closed reduction with the expectation of normal osseous repair and remodeling. We report a case of a previously fractured medial clavicle physis that abnormally remodeled, was reinjured, and resulted in posterior displacement with superior vena cava impingement and brachioplexopathy. Our case report describes the patient's initial injury and repair, the reinjury and discovery of abnormal remodeling, and the outcome of surgical intervention. We also include a review of recent literature on sternoclavicular joint injuries and treatment options. To our knowledge, this is the first reported case of an abnormally remodeled medial clavicle resulting in superior vena cava compression.