Surgical Management of the Infected Sternoclavicular Joint

Jackson, Rubie Sue; Carter, Yvonne M.; Marshall, M. Blair

doi:10.1053/j.optechstcvs.2013.02.001

Cited by 2 publications

(3 citation statements)

References 6 publications

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“…Of these, 11 patients with grade I-III infections were treated medically and exclusively with antibiotics, the remaining 11 patients with grade IV-V infections underwent limited surgery (incision, necrosectomy, debridement, irrigation and drainage of the joint). After a median follow-up period of 53 weeks, the infections healed in all patients, for which reason the authors recommend limited surgery in the absence of any major complications [21,22]. Prospective studies which validate this approach, however, are not available.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

“…Hiervon wurden 11 Patienten mit Grad-I- bis -III-Infektionen ausschließlich medikamentös-antibiotisch behandelt, die restlichen 11 Patienten mit Grad-IV-/-V-Infektionen wurden einer limitierten chirurgischen Therapie (Inzision, Nekrosektomie, Débridement, Gelenkspülung) zugeführt. Nach einer medianen Follow-up-Zeit von 53 Wochen heilten die Infektionen bei allen Patienten aus, weswegen die Autoren die limitierte chirurgische Therapie bei ausbleibenden Majorkomplikationen empfehlen 21 , 22 . Prospektive Studien zur Validierung dieses Vorgehens liegen allerdings nicht vor.…”

Section: Diskussion Und Literaturübersichtunclassified

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Innovative Surgical Concept for Septic Sternoclavicular Arthritis: Case Presentation of a Simultaneous Joint Resection and Stabilization with Gracilis Tendon Graft Including Literature Review

et al. 2020

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Introduction Septic arthritis of the sternoclavicular joint (SCJ) is a rarity in everyday surgical practice with 0.5 – 1% of all joint infections. Although there are several risk factors for the occurrence of this disease, also healthy people can sometimes be affected. The clinical appearance is very variable and ranges from unspecific symptoms such as local indolent swelling, redness or restricted movement of the affected shoulder girdle to serious consequences (mediastinitis, sepsis, jugular vein thrombosis). Together with the low incidence and the unfamiliarity of the disease among practicing doctors in other specialties, this often results in a delay in the diagnosis, which in addition to a significant reduction in the quality of life can also have devastating consequences for the patient. Patient and Method According to a stage-dependent procedure, the therapy strategies range from antibiotic administration only to radical resection of the SC joint and other affected structures of the chest wall in severe cases with the following necessity for flap reconstruction. The aspect of possible post-interventional instability after resection of the SCJ receives little or no attention in the current literature. In the present case report of a 51-year-old, otherwise healthy gentleman with isolated monoarthritis of the right SCJ with Escherichia coli (E. coli) shortly after two prostatitis episodes, the possibility of a new surgical approach with a one-stage eradication and simultaneous stabilization of the SCJ is presented. Therefore, a joint resection including extensive debridement is performed while leaving the posterior joint capsule and inserting an antibiotic carrier. In the same procedure, the SCJ is then stabilized with an autologous gracilis tendon graft by using the “figure of eight” technique, which has become well established particularly for anterior instabilities of the SCJ in recent years. Results and Conclusion One year after operative therapy, the patient presented symptom-free with an excellent clinical result (SSV 90%, CS89 points, CSM 94 points, TF 11 points, DASH 2.5 points). It is concluded that in selected cases with an infection restricted to the SCJ without major abscessing in the surrounding soft tissues, the demonstrated procedure leads to good and excellent clinical results with stability of the joint. If the focus of infection and germ are known, stabilization using an autologous graft can be carried out under antibiotic shielding. To the best of the authorsʼ knowledge, this surgical procedure has not yet been described in the current literature. Depending on the extent of the resection, an accompanying stabilization of the SCJ should be considered to achieve stable conditions and an optimal clinical outcome.

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Section: Discussion and Literature Reviewmentioning

confidence: 99%

Section: Diskussion Und Literaturübersichtunclassified

Innovative Surgical Concept for Septic Sternoclavicular Arthritis: Case Presentation of a Simultaneous Joint Resection and Stabilization with Gracilis Tendon Graft Including Literature Review

et al. 2020

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“…When a large defect remains, various options exist for muscle flap reconstruction (85). The pectoralis major can be used and receives its neurovascular supply from the thoraco-acromial bundle (86).…”

Section: Surgerymentioning

confidence: 99%

Diagnosis and management of sternoclavicular joint infections: a literature review

2020

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The sternoclavicular joint (SCJ) is anatomically and clinically significant considering its proximity to important neuro-vascular structures like the subclavian vessels and the phrenic nerve. Infections of this joint masquerade multiple disorders, delay diagnosis and spread to the bone and deep tissues. There is no standardized workup and treatment protocol for sternoclavicular joint infections (SCJI) as defined in literature. Here, we review the existing literature to understand the current knowledge of the diagnosis and treatment of SCJI. We searched English publications in PubMed and included clinical trials, case reports, case series, retrospective cohort studies, literature and systematic reviews after excluding non-infectious etiology of SCJ pathologies. There are many risk factors for SCJI, such as immunocompromised status, intravenous drug use, trauma and arthropathies. But a large percentage of patients with disease have none of these risk factors. SCJIs can present with fever, joint swelling, immobility, and rarely with vocal cord palsy or dysphagia. While Staphylococcus aureus causes over 50% of SCJI cases, other pathogens such as Pseudomonas and Mycobacterium are frequently seen. When diagnosed early, the infection can be medically managed with antibiotics or joint aspirations. Most cases of SCJI, however, are diagnosed after extensive spread to soft tissue and bones requiring en-bloc resection with or without a muscle flap. Complications of undertreatment can range from simple abscess formation to mediastinitis, even sepsis. SCJIs are rare but serious infections prompting early detection and interventions. Most cases of SCJI treated adequately show complete resolution in months while retaining maximum functionality. Key features of proper healing include aggressive physiotherapy to prevent adhesive shoulder capsulitis and decreased range of motion.

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Surgical Management of the Infected Sternoclavicular Joint

Cited by 2 publications

References 6 publications

Innovative Surgical Concept for Septic Sternoclavicular Arthritis: Case Presentation of a Simultaneous Joint Resection and Stabilization with Gracilis Tendon Graft Including Literature Review

Innovative Surgical Concept for Septic Sternoclavicular Arthritis: Case Presentation of a Simultaneous Joint Resection and Stabilization with Gracilis Tendon Graft Including Literature Review

Diagnosis and management of sternoclavicular joint infections: a literature review

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