Posterior Dislocation of Sternoclavicular Joint Encroaching on Ipsilateral Vessels in 2 Pediatric Patients

Abstract

Dislocation of the sternoclavicular joint (DSCJ) with posterior displacement of the clavicle is uncommon in children. This can lead to ipsilateral compression of the great vessels. Diagnosis may not be apparent on routine radiographs. Axial computed tomographic (CT) scan is the imaging of choice for diagnosis. Reconstruction and 3-dimensional (3D) views on CT scan may be helpful to define the anatomy before surgical reduction. We present 2 patients who had traumatic posterior DSCJ with compromise to their vascular structures. Patient 1 was a 13-year-old boy with posterior DSCJ on his left side that was not apparent on x-ray and that was diagnosed to have encroachment of the medial end of the clavicle on the left brachiocephalic vein on CT scan. Reconstruction and 3D views on CT scan were helpful in defining the anatomy before surgical reduction. The patient underwent emergent open reduction and internal fixation with complete recovery.Patient 2 was a 14-year-old boy with posterior DSCJ on the right side that was apparent on x-ray and was evaluated to have encroachment of the medial end of the clavicle on the right innominate artery with an associated paratracheal hematoma on CT scan. Reconstruction and 3D views on CT scan were also helpful in defining the anatomy before surgical reduction. The patient underwent a successful closed reduction with complete recovery.

Posterior sternoclavicular joint dislocation in a child: a case report with review of literature

“…22,24,26,34 As in our case, it is very difficult to distinguish between true posterior dislocation and posterior displacement of the medial clavicle physeal fracture from conventional radiograph or even CT scan. 16,22,32 The true nature of the injury can only be verified during open reduction 16,22,32,33,53 or retrospectively when new bone formation and bone remodeling is seen in follow-up CT scans. 34 This is why many of the reports do not make a clear distinction between these 2 injuries, especially when managed nonoperatively, and are generally reported and treated as posterior dislocations of the SCJ.…”

“…24,25 Another technique involves a combination of the above and applying a pressure on the shoulder in anterior posterior direction. 25,53 If this is unsuccessful, then the sternclavicular area is surgically prepped and traction on the abducted arm is applied with backward traction on the ipsilateral shoulder. A sterile towel clap is applied around the medial end of the clavicle and pulled anteriorly.…”

Judo-Related Traumatic Posterior Sternoclavicular Joint Dislocation in a Child

“…5 The SC joint ligaments require a considerable amount of force to be disrupted. 3,4,9 A careful physical examination is of utmost importance to rule out serious complications caused by trauma or persisting compression of the mediastinal structures by the displaced clavicle: hemorrhage, hematoma, respiratory distress, pneumothorax, hemothorax, tracheal and esophageal rupture, vessel compression, neurologic damage. [6][7][8][9] Three mechanisms of PSCJD ( Figure 4) are described in the literature: 2.…”

“…That explains why PSCJD is so frequent in combat and collision sports. [3][4][5]7,9 Apart from thorough clinical examination, radiological imaging is also essential for a complete diagnosis. A blow to the contralateral shoulder can carry the same results when the ipsilateral shoulder is firmly immobilized.…”

Safe surgical technique: reconstruction of the sternoclavicular joint for posttraumatic arthritis after posterior sternoclavicular dislocation

“…While uncommon, posterior sternoclavicular dislocations represent potentially life-threatening injuries due to the close proximity of the posterior mediastinal structures [9,10]. Aside from the risk of a vascular injury [11], tracheal tears and esophageal compression have been described, which lead to acute dyspnea and dysphagia [12]. Additional associated injuries include a traumatic vocal cord palsy [13] and brachial plexus injury [14].…”