Diagnosis and treatment of posterior sternoclavicular joint dislocations in children

Posterior dislocation of the sternoclavicular joint is uncommon in children, difficult to diagnose, and may be confused with a physical injury of the medial clavicle. We reviewed our experience with posterior dislocations of the medial clavicle over a 10-year period, and found 5 children who had sustained this injury. The computed tomography (CT) scan was found to be the best diagnostic procedure to assess the integrity of the sternoclavicular joint. The cause of the dislocation was most commonly lateral compression of the shoulders sustained during contact sports, particularly football and hockey. Reduction was usually obtained by retraction of the shoulders; for persistent dislocations, a towel clip was used to lift the medial end of the clavicle into its reduced position with the patient under general anesthesia. Reduction was maintained with a figure-of-eight bandage. Any child presenting with pain and swelling in the region of the sternoclavicular joint and no evidence of obvious fracture of the clavicle should have the possibility of dislocation of the sternoclavicular joint investigated with a CT scan.