Surgical management of sternoclavicular joint septic arthritis

Abstract

Introduction: Infections of the sternoclavicular joint (SCJ) account for less than 1% of all joint infections. There are no standardized diagnostic and therapeutic algorithms defined in literature. This study intended to report the risk factors, the bacterial spectrum, the extent and localization and the clinical outcome of SCJ infections. Patients and methods: We retrospectively reviewed the medical charts of 13 patients (8 men, five women, mean age 37.6 years) with SCJ infections between Januray 1st 2008 and October 30th 2015 for clinical parameters and radiological studies. All patients were interviewed during their follow-up along with clinical examination and assessing the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Results: Nine patients presented with local chest pain and swelling; in 4 patients, the prevalent symptom was pain without local signs of inflammation. Full blood count revealed a mean leukocytosis of 15 Â 10 9 L and a mean CRP of 21.0 mg/dl. Approximately 61.5% reported known diabetes mellitus. 10 patients presented an involvement of surrounding structures. All patients received a preoperativ CT scan. Each patient was treated via SCJ resection without intraoperative complications. Primary wound closure was possible in all cases. The mean follow-up was 95 days. Wound culture revealed Staphylococcus aureus in all patients. Pathological examination affirmed acute osteomyelitis in 7 patients. Four patients required the intensive care of which 2 patients died from septic shock. Recurrent infection was encountered in 3 patients who underwent revision surgery. Mean DASH Score was 18.7. Conclusion: CT should be routinely obtained to recognize the possible extends to the surrounding structures. SCJ resection can result in satisfactory clinical results and should be considered in cases of extended infections including the surrounding structures. Empiric antibiotic coverage should contain cephalosporin or extended-spectrum penicillin. Inappropriate or less-invasive surgical procedures may cause recurrencent infections, especially in cases of osteomyelitis.

The Preferred Treatment of Sternoclavicular Joint Infections: A Systematic Review

“…Overall, complication rates varied from 0% (Jang et al) to 40% (Bakaeen et al. and Puri et al) [ 4 , 15 , 16 , 21 ]. The mean follow-up ranged from three months (Von Glinski et al) to 53 months (Jang et al), as shown in Table 6 [ 4 , 21 ].…”

“…), and 23% (Von Glinksi et. al) [ 1 , 3 , 13 , 21 ]. Two of these studies further stratified the recurrence of infection by treatment modality and/or closure technique.…”

Pyogenic Arthritis of the Left Sternoclavicular Joint with Clavicular Osteomyelitis and Mediastinal Abscess without Obvious Triggers

“…In fact, histopathological examination of the bone and soft tissue of the SCJ obtained intraoperatively revealed that bone destruction and granulation tissue formation were advanced, along with signs of osteomyelitis. Although there are no standardized diagnostic algorithms for pyogenic arthritis of the SCJ 9) , diagnosis is based on the above-mentioned clinical and image findings such as bone destruction, joint space enlargement, and infectious complications by ultrasound, radiography, CT, and MRI. Gram stain and culture of joint fluid obtained by arthrocentesis and blood revealed a bacterial infection.…”

“…Any remaining infected bone or cartilage may cause reinfection 12) . If the infection involves a wide area, adequate surgical management is required, including SCJ and rib resection 9) . Careful attention should be paid not to damage the adjacent great vessels, and cooperation with other departments such as thoracic surgery and orthopedic surgery is essential during surgery in the SCJ, posterior sternum, and thorax area.…”

Diagnostics and Treatment of Purulent Arthritis of the Sternoclavicular Joint

“…Запальне ураження ГКС -рідке захворювання, що потребує хірургічного лікування [1,2]. Інфекція ГКС в більшості випадків асоційована з цукровим діабетом, ін'єкційною наркотичною залежністю, лікуванням імуносупресорами, ревматичними хворобами [2,3,4,5]. На початкових етапах розвитку хвороби місцеві зміни незначні, а диференційний ряд болю в ділянці суглобу включає нехірургічні захворювання [6,7].…”