Sun Tzu Art of War-Inspired Technique for the Elusive Sternoclavicular Joint (SCJ) Arthritis: The Badortho Procedure

Sternoclavicular (SC) joint arthritis and instability are uncommon and often diagnostically and therapeutically challenging due to complex anatomy and proximity to vital mediastinal structures. We describe a unique staged management strategy inspired by the Chinese military stratagem Sheng Dong Ji Xi ("feign attack in the east, strike in the west"), as well as a new distal clavicle resection surgical technique, whereby symptomatic functional impairment was ultimately addressed through targeted distal clavicle resection while leaving a chronic painless SC joint dislocation untouched. This case highlights the importance of understanding the anatomy and biomechanics of the skeletal structure and demonstrates a pragmatic strategy for managing complex clavicular joint pathology. We name this novel surgical technique the Badortho sternoclavicular joint (SCJ) procedure. A 37-year-old male motorcyclist sustained anterior sternoclavicular (SC) joint subluxation following trauma. Initial conservative management failed due to persistent instability. Open SC stabilization with anchor sutures failed within eight months, requiring revision reconstruction using gracilis autograft to reconstruct the costoclavicular ligament. The patient initially returned to work; however, he developed worsening pain over the sternoclavicular joint, especially during axial loading of the upper limb. In view of multiple procedures done over SCJ, we decided on a different approach where we reduced the force transfer to the SCJ through lateral clavicle excision. The patient underwent a Badortho SCJ procedure, an open lateral distal clavicle excision of 15 mm, with preservation of stabilizers of the acromioclavicular joint. At two-year follow-up, he achieved a full range of motion and a pain score of zero. Chronic painless anterior SC dislocation persisted but required no further intervention. This case highlights the potential of this new surgical approach, which is less invasive and less demanding to treat complex SCJ arthritis.