A Transarticular Approach to Posterior Sternoclavicular Dislocation: A Case Report
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CASE REPORT
A Transarticular Approach to Posterior Sternoclavicular Dislocation: A Case Report Steven M. Kane, MD & Darrell V. Morris, MD & Adrian N. S. Badana, PhD, MPH
Received: 21 February 2020/Accepted: 9 June 2020 * Hospital for Special Surgery 2020
Keywords sternoclavicular joint . joint dislocation . orthopedic procedures Introduction The incidence of dislocation of the sternoclavicular (SC) joint represents less than 1% of all dislocations in the body and approximately 3% of all shoulder injuries; the majority of shoulder dislocations are anterior [3, 4]. Posterior dislocations are rare and may have life-threatening complications due to their close proximity to the superior mediastinum and its vascular structures. Untreated posterior SC dislocations often result in symptoms of dysphagia, venous congestion, and arterial insufficiency [8]. We report a case, with 5-year follow-up, describing the successful anterior surgical stabilization of a posterior SC dislocation. Surgical dissection in the retrosternal and posterior clavicular space was prohibited to avoid additional risk to previously traumatized and/or repaired vascular structures. Case Presentation A 21-year-old man was admitted to our trauma center after being struck as a pedestrian by a vehicle traveling at 50 mph. (The patient provided written consent to have details of his case reported.) He was immediately intubated in the trauma bay due to mid-face fractures and bloody secretions. The patient sustained extensive soft tissue injuries with active bleeding from the left base of the neck. His first evaluation blood pressure was 85/45 mmHg. Subsequent studies showed that he sustained mandible fractures, a left renal hilum hemaS. M. Kane, MD : A. N. S. Badana, PhD, MPH (*) Department of Orthopedics, Wellstar Atlanta Medical Center, Atlanta, GA, USA e-mail: [email protected] D. V. Morris, MD Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
toma, bilateral first rib fractures, bilateral pulmonary contusions, C4–C6 transverse process fractures, closed right tibia and right fibula fractures, multiple deep lacerations to the left neck and trunk, and a left posterior SC joint dislocation. A vascular surgeon was consulted emergently due to heavy bleeding at the base of the neck and the areas surrounding the SC joint, medial clavicle, and external jugular vein. A subsequent surgical exploration of the penetrating neck wound was performed in the operating room for hemorrhage control; ligation of several external jugular venous tributaries was necessary to control bleeding. At that time, a reduction of the left posterior SC joint dislocation was attempted but aborted without success or subsequent joint reconstruction after the vascular surgeon asked that no further manipulation of the area be entertained to prevent reinjury of the tenuous vascular structures at the base of the neck. The wounds overlying the left SC joint were loosely closed with the intent of a repeat incision and drainage and exploration several days later. The pat
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