Paediatric Sternoclavicular Joint Pseudodislocation Fixation Technique

Posterior sternoclavicular joint (SCJ) injuries in children are rare and frequently misdiagnosed. Due to the anatomy of the immature medial clavicle, many of these injuries are Salter-Harris type I/II physeal fractures rather than true joint dislocations-termed pseudodislocations. These injuries require careful diagnosis and tailored management to ensure safe and functional outcomes.

Surgical intervention is indicated in paediatric SCJ pseudodislocations with significant posterior displacement of the medial clavicular fragment, particularly when the posterior metaphysis poses a risk to mediastinal structures or functional deficits persist.

We describe a paediatric SCJ pseudodislocation fixation technique performed at the Royal Children's Hospital in Melbourne. The patient is positioned supine with a bolster behind the shoulders. A curvilinear incision is made, and dissection is performed to identify the clavicular diaphysis and sternum. The fracture is reduced under direct vision with a reduction clamp, blunt periosteal elevator, and axial traction. An anterior-inferior drill hole is made in the medial clavicular metaphysis, and 2 anterior drill holes are created in the sternum. Fibertape is passed in a double figure-of-8 configuration through the posterior clavicle, disc, and posterior sternal cortex, before being tied anteriorly over the sternum and clavicle. This anterior-directed force resists further posterior subluxation. The capsule and strap muscles are repaired to restore soft tissue support.

In our internal audit of 30 paediatric posterior SCJ pseudodislocations treated operatively over a decade, this technique consistently resulted in anatomical reduction, full range of motion, and return to sports. Complication rates were low. Computed tomography confirmed the reduction, and rehabilitation was tailored to the biology of physeal injuries, allowing an earlier return to activity compared with soft-tissue dislocations.

Posterior SCJ pseudodislocations can be safely and effectively managed with this transosseous fibertape fixation technique. Restoration of anterior stability using a double figure-of-8 construct provides strong mechanical support while preserving anatomy. Accurate diagnosis, surgical planning, and soft tissue repair are essential. This technique facilitates a reliable return to sports and function, with minimal complications.

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