Sternoclavicular joint surgery: how far does danger lurk below?

Management and functional outcomes following sternoclavicular joint dislocation

“…Despite a relatively low incidence of intraoperative neurovascular incident, anatomical studies display the close proximity of mediastinal structures to the SCJ, highlighting the potential risk which may have devastating consequences [15]. The majority of studies in the literature recommend having a cardiothoracic surgeon available for any open reduction of a posteriorly dislocated SCJ [6,8,10,15,17,24].…”

“…The posterior capsule is the most important structure in preventing anterior and posterior translations of the medial clavicle, and the intra-articular disc prevents superior and medial displacement [7,14]. There are multiple important structures in close proximity to the SCJ, including the subclavian vessels, the great vessels of the neck, the brachial plexus, trachea, oesophagus, vagus nerve and the superior aspect of the pleura [15]. An anatomical study from 2013 examining the distance of critical mediastinal structures from the SCJ reported that the closest at-risk structure is the brachiocephalic vein which had an average distance of 6 mm (range 1-10 mm) [15].…”

“…The patients' age and previous radiation exposure must be considered when using this modality. CT can also provide information relating to surrounding structures and associated potential complications, and aid with operative planning [3,15,20].…”

Outcomes of augmented allograft figure-of-eight sternoclavicular joint reconstruction

“…5,14 However, when injuries do occur, significant morbidity may result because of the proximity of the clavicle to important mediastinal vascular and visceral structures. 20 Whereas injuries to the SCJ are often traumatic, atraumatic mechanisms can also result in recurrent instability. 13 Acute and chronic anterior and posterior SCJ instabilities are potential sequelae of injury, which in rare cases may require surgical ligamentous reconstruction.…”

CORR Insights®: Does Patient Sex Affect the Anatomic Relationships Between the Sternoclavicular Joint and Posterior Vascular Structures?

“…They recommended having a cardiothoracic surgeon available during reconstruction of the SCJ. In separate studies by Sinha [4], Li [2], and Ponce [3], the closest vessels posterior to the medial clavicle or sternum averaged around 12 mm, 24 mm, and 7 mm, respectively; reiterating the close proximity of the vascular structures to the SCJ. Ponce [3] found significant right-left differences but no significant gender differences.…”