[Sternoclavicular dislocations. Observations on the treatment and result of 49 cases]

Over a period of 19 years, 49 dislocations of the sternoclavicular joint were treated. Two were epiphyseal separations. The dislocation was an isolated injury in only 41% of the patients. There were associated injuries to the scapula in 55% and to the thorax in 37%. Forty dislocations were anterior, 8 retrosternal and one merely unstable. Seventeen were treated by operation, 15 by closed reduction and 17 were left untreated. We have been able to review 55% of these patients with an average follow up of 6.7 years; 15 were between 2 and 6 years after injury, and 12 between 6 and 16 years. The end result was achieved by 3 months; 42% of patients had an excellent result, 58% were satisfied and 25% disappointed with the final outcome. Operative treatment gave 66% of excellent results, whereas immobilisation, particularly with unreduced dislocations, accounted for most of those judged unsatisfactory. Closed treatment should be undertaken initially, but if reduction is not achieved an operation should be carried out. If old unreduced dislocations are unsatisfactory they should be stabilised by myoplasty, or by excision of the inner end of the clavicle if the articular surface is damaged.