A three-stage procedure using bone transportation for the treatment of sternoclavicular infectious arthritis
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RESEARCH ARTICLE
Open Access
A three-stage procedure using bone transportation for the treatment of sternoclavicular infectious arthritis Hua Chen†, Xinran Ji†, Ming Hao, Qun Zhang* and Peifu Tang*
Abstract Background: Sternoclavicular joint (SCJ) infectious arthritis is a rare disease. A standard treatment for SCJ infection has not been established. This study aimed to assess the clinical outcomes of a three-stage procedure with bone transportation (BT) for treating SCJ infectious arthritis. Methods: Six patients (mean age 39.5 years) with chronic SCJ infectious arthritis were included in the study. The patients underwent a three-stage treatment between January 2009 and December 2012, and results were analyzed retrospectively. Following debridement, immediate flap closure was conducted, and BT of the clavicle was performed to fill the gap using a monolateral external fixator. SCJ reconstruction with a tendon autograft was performed, and the external fixator was finally removed. Clinical outcomes were evaluated using Disabilities of the Arm, Shoulder, and Hand (DASH) scores and Constant scores. The average follow-up period was 16 months (range 12–36 months). Results: The DASH scores decreased from 53.6 ± 4.9 preoperatively to 24.4 ± 3.1 postoperatively. The Constant scores for pain, activity level, positioning, strength, and range of motion were significantly high after the treatment. The total Constant score improved from 32.5 ± 5.8 preoperatively to 76.7 ± 6.4 postoperatively. All patients were satisfied with the therapeutic effect. No complications occurred. Conclusions: The three-stage procedure with BT improves shoulder function and movement and relieves pain. It is an effective and safe method for treating SCJ infectious arthritis. Keywords: Sternoclavicular infectious arthritis, Three-stage procedure, Bone transportation, Reconstruction
Background Sternoclavicular joint (SCJ) infectious arthritis is an unusual disease accounting for 1% of all bone and joint infections [1]. Treatment of SCJ infection is difficult because of the close proximity of major vascular structures and lack of substantial overlying soft tissues [2]. Surgery may be performed when conservative treatment fails. Surgical options include incision and drainage, curettage, and/or SCJ resection [2–5]. These procedures require debridement of the structures stabilizing the SCJ, such as the anterior or posterior SCJ ligaments as well as costoclavicular and interclavicular ligaments, with relatively frequent involvement of the first and even second rib [6]. * Correspondence: [email protected]; [email protected] † Equal contributors Department of Orthopaedics Surgery, General Hospital of PLA, Fuxinglu 28, Haidian District, Beijing 100853, China
Most patients with SCJ instability complain of discomfort, clicking, and pain because the joint is often dislocated [7–9]. Therefore, an increasing number of surgeons consider it important to restore the joint stability to improve upper extremity function, resulting in the development of other methods su
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