Pediatric Posterior Sternoclavicular Joint Injuries

Abstract

Posterior sternoclavicular joint injuries are increasingly diagnosed in children and young adults. Most of these injuries are the result of indirect mechanisms, typically lateral compression, with a posterior-to-anterior force applied to the shoulder during sports. Less frequently, these injuries are caused by direct impact on the medial clavicle, which can occur in rollover motor vehicle accidents, or may represent atraumatic instability. In patients younger than 25 years, physeal separation is more common than true dislocation. Theoretically, these patients have increased remodeling potential. Reduction is recommended to prevent and/or manage the compression of mediastinal structures, which can lead to life-threatening injury. Open surgical stabilization is the preferred treatment for acute and chronic retrosternal injuries. A thoracic or trauma surgeon should be available during stabilization in the rare event of potentially life-threatening hemorrhage after reduction. Outcomes have been largely successful, with pain-free, unrestricted range of motion and return to activity.

Keywords: medial physeal injury; mediastinal injury; retrosternal injury; sternoclavicular dislocation.