An Epidemiologic Review of Vascular Complications in Pediatric Posterior Sternoclavicular Dislocations: Implications...

Posterior sternoclavicular dislocation (P-SCD) is a rare injury of the shoulder girdle often occurring after falls, motor vehicle accidents, or sports injuries. Given the proximity of the sternoclavicular joint to major mediastinal vessels, current guidelines recommend a cardiothoracic (CT) surgeon to be on standby during operative treatment. However, the true incidence of vascular complications following P-SCD, particularly in pediatric populations, remains poorly defined. The purpose of this study is to quantify the incidence of vascular injury associated with pediatric P-SCD using a large, multi-institutional database to help better characterize the need for a CT surgeon to be on standby.

A retrospective cohort study was conducted using the TriNetX Research Network, which identified patients aged ≤21 years with P-SCD (ICD-10-CM S43.22∗) between 2015 and 2025. The primary outcome was thoracic vascular injury, identified by ICD-10-CM codes S25.X during the index encounter. Patients were classified as having isolated P-SCD or polytrauma based on co-coded injuries during the index encounter. Demographics and injury characteristics were summarized descriptively, and comparisons between patients with and without vascular injury were assessed using t-tests and χ² tests (P < .05).

A total of 432 patients were identified, with a mean age of 15.9 years. Vascular injury occurred in 1.2% of the cohort (n = 5), all of whom presented with polytrauma. No vascular injuries were observed among patients with isolated P-SCD. Patients with vascular injury had significantly more injury regions (mean 6.8 vs 0.94; P < .01) and longer hospital stays (mean 11.4 vs 2.3 days; P < .01). Patients with vascular injury were also older on average compared to patients without vascular injury (19.20 vs. 15.82 years , P < .01).

Vascular injury following pediatric P-SCD is rare and was observed only in patients with polytrauma. These results suggest that routine CT surgery to be on standby may require reevaluation as the standard practice. While not intended to change clinical guidelines, this study provides critical epidemiological data and highlights the need for further prospective research to inform surgical protocols.

(1)Posterior sternoclavicular dislocation (P-SCD) is an uncommon shoulder girdle injury with potential for serious mediastinal complications.(2)Current surgical guidelines recommend cardiothoracic (CT) surgeon to be on standby during operative management of P-SCD due to possible vascular injury.(3)In this large, multi-institutional pediatric cohort, vascular injury following P-SCD was observed in only 1.2% of cases.(4)All vascular injuries occurred exclusively in patients presenting with polytrauma, and none occurred in isolated P-SCD.(5)These findings suggest that a CT surgeon on standby may warrant reevaluation in isolated pediatric P-SCD and that further prospective research is needed to refine risk stratification.

Level IV, Retrospective Cohort Study.