Emergent Management of Traumatic Posterior Sternoclavicular Joint Dislocation: A Case Report and Literature Review

Abstract

Sternoclavicular joint (SCJ) dislocation is a rare but serious orthopedic injury. Posterior dislocations are more concerning due to the SCJ's proximity to visceral structures such as the trachea, esophagus, subclavian vessels, and brachial plexus. Due to the potential long-term sequelae of missed diagnosis, clinical suspicion should be high when a patient presents with a compression-type injury to the shoulder girdle and pain or deformity to the SCJ. Here we present a case of a 15-year-old soccer player who presented to the emergency department (ED) after a fall onto his right shoulder with additional compound injuries. A posterior SCJ dislocation diagnosis was suspected and confirmed after a computed tomography scan. A successful closed reduction was done in the ED after consultation with cardiothoracic and orthopedic surgery. This case adds to the body of literature describing diagnosis and management of posterior SCJ dislocations.

Keywords: case report; closed reduction; computed tomography; sternoclavicular joint; traumatic sternoclavicular joint dislocation.

Figure 1. A) Anterior-posterior X-ray of the chest on arrival. B) Axial CT view demonstrating posterior dislocation of the right sternoclavicular joint. C) Axial three-dimensional (3D) CT reconstruction. D) Coronal 3D CT reconstruction.

CT: computed tomography, R: right, L: left

Figure 2. A) Reduction technique using percutaneous towel clamp forceps engaging the medial aspect of the dislocated clavicle while the other hand stabilizing the sternum. B) Axial CT showing anatomical reduction of posterior dislocation of the right sternoclavicular joint. C) Post-reduction axial CT reconstruction. D) Post-reduction coronal CT three-dimensional (3D) reconstruction.

CT: computed tomography, R: right, L: left