Parallel Plating for a Sternomanubrial Dislocation

Abstract

Sternomanubrial dislocations are rare injuries. Although few cases of this injury have been reported in the literature, the etiology has varied widely: trampoline injury, seizures, falls from height, sporting injuries, gradual deformities from spine fractures, and motor vehicle collisions. This injury has been classified into 2 types: in type I, the sternal body is displaced posteriorly to the manubrium, and in the more common type II, the sternal body is displaced anteriorly. The sternomanubrial joint is an amphiarthroidal joint that bears hyaline cartilage on both surfaces connected by a fibrocartilage meniscus. It serves a protective role to vital thoracic structures and is an anterior stabilizing strut to the thorax, assisting the thoracic spine in upright stability. It is important to not ignore type I dislocations because posterior sternum displacement is a harbinger of injury to the pulmonary tree, heart, and esophagus. Chronic instability at this joint can lead to dyspnea and dysphasia due to sternum displacement. In the right scenario, type II injuries are occasionally treated conservatively with palliative treatment until the sternum heals with malformation. This article describes the case of a 20-year-old man who was treated surgically for symptomatic type II sternomanubrial dislocation with dual anterior locked plating. Locked plating gives the benefit of unicortical fixation, with the screws and plate acting as a unit to resist motion. Screw pullout and failure is less common, and the construct is more resistant for this application. The patient returned to full participation in activities of daily living and military duty 4 months postoperatively.

Operative Reduction and Fixation of a Sternomanubrial Dislocation: A Case Report and Literature Review

“…3 The sternum provides protection for thoracic structures and acts as an anterior stabilising strut for the thorax. 5 Two types of sternomanubrial dislocations have been established: type I is where the sternal body is dislocated posteriorly to the manubrium, while type II is where the sternal body is dislocated anteriorly to the manubrium. 5,6 Type I injuries are associated with direct impact, while type II injuries are associated with hyperflexion of the thoracic spine.…”

“…5 Two types of sternomanubrial dislocations have been established: type I is where the sternal body is dislocated posteriorly to the manubrium, while type II is where the sternal body is dislocated anteriorly to the manubrium. 5,6 Type I injuries are associated with direct impact, while type II injuries are associated with hyperflexion of the thoracic spine. 5,6 Type I dislocations can be particularly dangerous due to the risk of injury to the pulmonary tree, heart, and esophagus.…”

“…5,6 Type I injuries are associated with direct impact, while type II injuries are associated with hyperflexion of the thoracic spine. 5,6 Type I dislocations can be particularly dangerous due to the risk of injury to the pulmonary tree, heart, and esophagus. 5 Such injuries are confirmed using lateral chest x-rays or computed tomography (CT) scans.…”

“…5,6 Type I dislocations can be particularly dangerous due to the risk of injury to the pulmonary tree, heart, and esophagus. 5 Such injuries are confirmed using lateral chest x-rays or computed tomography (CT) scans. Several methods of treatment including nonoperative and operative methods have been described.…”

Surgical Management of Traumatic Manubrio-Sternal Dislocation With Locking Compression Plate; A Case Report and Review of Literature.

“…The materials used for fixation of displaced manubrio-sternal joint are steel wires [1], Polydioxanone ropes [2], and Plates with screws [1,3,4].…”