Traumatic sternoclavicular joint injuries are uncommon, especially in the skeletally immature. Most of these injuries do not represent true dislocations but rather growth plate fractures of the medial clavicle physis. Posterior injuries are urgent as they may cause compression of the surrounding neurovascular bundles. This paper discusses surgical treatment of anterior instability done over a five year span. Twenty-four patients were identified who underwent either sternoclavicular joint reconstruction or medial clavicle resection for chronic recurrent anterior instability. Fifteen patients were available for long-term follow up at an average time of 55 months from surgery. Eleven patients underwent repair or reconstruction and four involved resection of the medial clavicle. Reconstruction involved using either semitendinosus tendon or sternocleidomastoid fascia. The repair was reinforced with non-absorbable suture. Medial clavicle resection was done when there was degenerative arthrosis of the sternoclavicular joint. The medial 2 cm to 2.5 cm of clavicle was removed. When possible, the surrounding periosteum and costoclavicular ligaments were repaired to provide stability to the medial clavicle during closure.
Follow up was obtained via clinical examination, mail survey and telephone contact. Sternoclavicular joint instability was graded on a scale from 1 to 3. In addition, an evaluation using the American Shoulder and Elbow Surgeons’ Shoulder Assessment Form and a Simple Shoulder Test was included. The results show that most patients reported stable pain-free shoulders. There was some mild instability in four patients and persistent instability in two patients. Eighty-seven percent patients had some difficulty in athletic or recreational activity, especially with overhead motion or high velocity pitching. The mean American Shoulder and Elbow Standard Shoulder Assessment Form showed near normal results with some limitation. There was little difference between medial clavicle resection and sternoclavicular joint reconstruction although the numbers are small.
Traumatic sternoclavicular joint dislocations are uncommon and treatment of chronic cases remains unclear. Many authors recommend conservative measures unless symptoms arise. This investigation assessed the functional results of surgical stabilization and medial clavicle resection. Overall, the patients did well with no major complications from surgery. However, restriction in overhead activity was noted, especially overhead throwing, heavy lifting and rigorous activity. This information is important to relay to patients and families when considering reconstruction or medial clavicle resection following chronic dislocation.
Clavicle, Sternoclavicular, Joint, Reconstruction, Instability
Journal of Pediatric Orthopaedics