All-Suture Repair of a Posterior Sternoclavicular Fracture Dislocation in an Adolescent Athlete
Cole Morrissette1, Lauren Redler1
1Department of Orthopedic Surgery, Columbia University, New York, USA.
Background:
Posterior sternoclavicular (SC) physeal separations are rare injuries in adolescents and pose a significant risk of life-threatening complications due to potential compression of vital mediastinal structures. This necessitates prompt diagnosis and stable fixation to ensure safe healing and return to function.
Indications:
The primary indication for surgery was an acute, unstable, posteriorly displaced physeal fracture of the medial clavicle in a 14-year-old competitive jiu-jitsu athlete. Computed tomography revealed the displaced metaphyseal fragment abutting the junction of the right brachiocephalic vein and superior vena cava, making operative stabilization essential to mitigate the risk of neurovascular compromise.
Technique Description:
The procedure involved an open reduction of the displaced clavicular metaphysis and internal fixation using a physeal-respecting, all-suture repair. High-strength suture tapes were passed through transosseous tunnels created in the medial clavicular epiphysis and the metaphysis, creating a low-profile, robust construct that anatomically reduces the fracture.
Results:
At 3 months postoperatively, the patient had a well-healed, nontender incision with full, painless range of motion. Radiographs confirmed anatomic union, and the patient was cleared for an unrestricted return to competitive jiu-jitsu.
Discussion/Conclusion:
An all-suture, open reduction and internal fixation is a safe and effective treatment for posterior SC physeal separations in adolescent athletes. This physeal-respecting technique provides the stability necessary for a reliable return to high-impact sports while avoiding implant-related morbidity and preserving the growth potential of the medial clavicle.
Patient Consent Disclosure Statement:
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
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Assessment:
1. Clinical Evaluation:
History: