Sternoclavicular Dislocations

EpidemiologySCJ Anterior DIslocation

 

Extremely uncommon

Stability provided by joint capsule /costoclavicular & interclavicular ligaments 

 

Recurrent instability uncommon

 

Many apparent dislocations in adolescents may be growth plate injuries 

-will remodel without treatment

 

If OA from chronic dislocation may resect SCJ

 

Types

 

Anterior & posterior 

 

Posterior

- more serious injury

- least common

 

Diagnosis 

- difficult on physical examination

- radiographs often are non diagnostic

- most consistent diagnostic modality = CT

 

Anterior 

 

SCJ CT Anterior DislocationSternoclavicular Anterior Dislocation

 

Usually managed non-operatively

- with activity modification and reassurance

 

MUA 

- often will redislocate

 

Open reduction

- need to stabilise

- can use strip PL to stabilise

- uncertain if any benefit 

 

Posterior 

 

CT Posterior SCJ Dislocation

 

May require treatment because of proximity of major neurovascular structures and airway 

 

1.  Closed reduction

- performed under GA in operating room 

- chest surgeon available

- potential vascular / airway catastrophe associated with injuries to the mediastinum

- thorough vascular exam pre-operatively

 

2.  Assess stability

 

Successful closed reduction usually stable

- avoid internal fixation because of likelihood of hardware migration

- possible injury to the mediastinal structures

 

Closed reduction unsuccessful

- open reduction is indicated

- can stabilize with PL graft / intra-osseous sutures

 

SCJ Open ReductionSCJ Reduction 2SCJ Suture Fixation