Traumatic posterior sternoclavicular joint dislocation - Current aspects of management

Area of Science:

• Orthopedic Surgery
• Trauma Management
• Vascular Surgery

Background:

• Posterior sternoclavicular joint dislocations are rare, potentially life-threatening injuries.
• Massive hemorrhage is a significant risk during trauma and reduction.
• Collective experience in managing these injuries is vital.

Purpose of the Study:

• To present a multidisciplinary experience in managing posterior sternoclavicular joint dislocations.
• To identify key learning points for optimal patient care.
• To highlight strategies for managing associated hemorrhage.

Main Methods:

• Multidisciplinary team approach involving orthopedic and cardiothoracic surgeons.
• Assessment using Computerised Tomography Angiography (CTA) to evaluate vascular proximity and bleeding.
• Both closed and open reduction techniques were employed, with emphasis on vascular control measures.
• Pre-emptive venous catheterization considered for high-risk cases.
• Pre-operative discussion and rehearsal for intra-operative bleeding management.

Main Results:

• Five cases were managed, with one closed reduction and four open reductions.
• Closed reduction within 48 hours showed high success rates.
• Open reduction was necessary for a physeal fracture with delayed presentation.
• Palmaris graft with internal bracing was the preferred reconstruction method.
• Some patients experienced persistent globus sensation or voice changes post-reconstruction.

Conclusions:

• Posterior sternoclavicular joint dislocations require a coordinated, multidisciplinary approach.
• CTA is essential for pre-operative planning.
• Vascular control, ideally by a cardiothoracic surgeon, is paramount during reduction.
• While surgical outcomes can be favorable, persistent symptoms like globus sensation may occur.