The management of Salter-Harris type II fracture with associated posterior sternoclavicular joint displacement using a locking compression plate

Abstract

Rationale: Posterior sternoclavicular joint dislocations (PSCJDs) are particularly rare injuries, accounting for 3% to 5% of sternoclavicular joint dislocations. With very few cases reported in the literature, these injuries are often misdiagnosed and imaging is not always clear, thus making physicians often unaware of them. The present case report aims to investigate a rare case involving a clavicular Salter-Harris II fracture with associated posterior displacement of the diaphysis, a term coined a “pseudodislocation.” Patient concerns: We present a case of a 14-year-old adolescent who sustained a traumatic injury to the shoulder while falling during a soccer match. His main concern was about recovery time and the return to daily life activities. Diagnoses: Multiple imaging studies imaging (X-rays, computed tomography, magnetic resonance imaging) revealed a Salter-Harris II fracture of the right clavicle with posterior displacement of the diaphysis. Interventions: The patient underwent primary surgery to reduce the fracture, using an articular locking compression plate, and secondary surgery to remove the hardware. Outcomes: Following the removal of the hardware at 60 days after the initial surgery and a number of cycles of physiotherapy the patient reported a pain-free range of motion with slight limitation at extremes. Full return to recreational and everyday life activities were achieved at 3 months from the initial surgery. Lessons: The PSCJDs are challenging injuries, as they are surrounded by delicate structures inside the mediastinum. Attention must be taken while diagnosing and treating these injuries as the risk of complications and iatrogenic injuries is high. To the author's knowledge, this case is one of the first of its kind described in the literature where we have a Salter-Harrys type II fracture associated with a posterior pseudodislocation of the lateral clavicle. Given the positive results of the case, we recommend the above-mentioned treatment protocol in PSCJD with associated Salter-Harris II fractures in adolescent patients.

Operative treatment outcomes of anterior sternoclavicular joint dislocation using two experimental methods - an acromioclavicular joint hook plate versus a locking plate: a retrospective study

“…Regardless of the surgical methods performed, important thoracic structures which exist behind the sternoclavicular joint, such as the trachea, esophagus, brachiocephalic vein, brachiocephalic artery, and brachial plexus, were protected from accidental injury caused by surgical treatment, especially on the sternal manubrium [ 3 , 14 , 15 ]. As a classical surgical method, LPs have been used for the reduction and fixation of the sternoclavicular joint [ 16 , 17 ]. Additionally, we also have reported the safety and efficacy of using an AJHP for the treatment of anterior sternoclavicular joint dislocation [ 13 ].…”

Treatment Outcomes of Anterior Sternoclavicular Joint Dislocation using An Acromioclavicular Joint Hook Plate Versus a Locking Plate: A Retrospective Study.

“…Important thoracic structures, such as the trachea, esophagus, brachiocephalic vein, brachiocephalic artery, and brachial plexus, exist behind the sternoclavicular joint, and surgical treatment may be required to prevent accidental injury, especially on the sternal manubrium [3,14,15]. As a classical surgical method, LPs have been used for the reduction and xation of the sternoclavicular joint [16,17]. We have reported the safety and e cacy of using an AJHP for the treatment of anterior sternoclavicular joint dislocation [13].…”

O-arm use in the surgical management of pediatric posterior sternoclavicular joint injury: a case report

“…There have been many different surgical techniques described in the literature; however, there is no widely accepted ideal surgical method. 1 , 2 , 3 , 5 , 14 , 15 A biomechanical cadaveric study done by Spencer and Kuhn 10 demonstrated that a figure-of-eight reconstruction restores superior joint stability compared with other techniques, especially in the posterior direction. Kendal et al 4 performed a systematic review of surgical management of traumatic posterior SCJDs in both adult and adolescent patient populations and found 45 different surgical techniques.…”