Management and outcome of traumatic posterior sternoclavicular dislocations at a paediatric major trauma centre

Sternoclavicular (SCJ) dislocations are rare, high-energy injuries. Of all SCJ dislocations only 3-5% are posterior and carry increased risk due to the proximity to the mediastinum. Due to small numbers being admitted to individual centres there is no universal management and rehabilitation plan. The purpose of this study was to assess the incidence, management, and outcomes of traumatic posterior SCJ dislocations.

This was a retrospective study looking at all posterior sternoclavicular dislocations in children 16 and under between 2013 and 2023 at a level 1 paediatric major trauma centre.

There was a male-to-female ratio of 9:1 with an average age of 14 (9-16). There were six rugby injuries, one football, one falling bale of hay, one fall when sprinting, and one mechanism unknown. Three were found to have mediastinal abnormalities. All underwent surgical fixation, five underwent two drill holes and fibre wire fixation, four had suture-only repairs, and one operation note was unclear. Two patients underwent a reoperation. Rehabilitation advice varied including how long to abstain from contact sports. Long-term follow-up with an average of 3 years showed an average Oxford Shoulder Score of 48 with excellent functional outcomes.

In conclusion, posterior sternoclavicular dislocations are rare injuries with no clear consensus on management. They should be managed in a paediatric major trauma centre due to the high risk of mediastinal damage. In our study two main surgical techniques were used and a range of rehabilitation instructions given however, all patients had excellent results at long-term follow-up.