Management of Posterior Sternoclavicular Joint Dislocation in a Teenager After a Direct Elbow Strike to His Clavicle: A Case Report

Abstract

Posterior dislocation of the sternoclavicular joint is a rare orthopedic injury and may result in complications with high mortality due to the location of the joint, accompanied by neurovascular, tracheal, and esophageal injuries. Therefore, an immediate diagnosis and treatment are necessary to prevent complications. In this case, a 13-year-old male patient received an elbow strike to the left clavicle while playing football. The patient presented to the emergency department with complaints of pain, a gap and deformity in the superior and medial part of his sternum, and numbness in his left upper extremity. For this orthopedic emergency, which is difficult to recognize on direct radiographs, a computed tomography was done, which detected a left sternoclavicular joint posterior dislocation. A closed reduction procedure was performed on the patient under sedation in the operating theatre. A serendipity view with the fluoroscopy showed a successful closed reduction. A shoulder arm sling was applied and the patient was followed regularly. In the fourth week, the shoulder arm sling was removed and exercises were started to increase joint movements. In the sixth week, muscle strengthening exercises were started and in the eighth week, a full range of motion was reached with full muscle strength without any deformity. In this case, possible mortal complications were prevented with early intervention in the posterior dislocation of the sternoclavicular joint. This case report shows that with timely rehabilitation, it is possible to achieve full joint range of motion of the shoulder and full muscle strength without deformity or the need for surgery.

Keywords: closed reduction; direct trauma to clavicle; dyspnea; posterior sternoclavicular joint dislocation; teenager sports injury.

Figure 1. Left shoulder anteroposterior radiographs before the and after the reduction

(A) Left shoulder anteroposterior radiograph before the reduction. The left sternoclavicular joint is marked with a red circle; (B) Left shoulder anteroposterior radiograph after the reduction. The left sternoclavicular joint is marked with a green circle.

Figure 2. Three-dimensional reconstructed computed tomography of the patient after the trauma before the closed reduction

Anterior (A), lateral (B), inferior (C), magnified anterior (D), magnified lateral (E), and magnified inferior (F) views. The left sternoclavicular joint is marked with a yellow ellipse.

Figure 3. Axial computed tomography sections of the patient after the trauma before the closed reduction

The left sternoclavicular joint posterior dislocation is remarkable with the consecutive axial computed tomography sections (A, B, C) after the trauma before the closed reduction. The proximal end of the left clavicle is marked with a blue circle. The proximal end of the right clavicle is marked with a green circle. The sternum is marked with a red ellipse and circle.