Traumatic Posterior Sternoclavicular Joint Dislocation With a Five-Day Delayed Presentation: A Case Report

Abstract

Posterior sternoclavicular joint (SCJ) dislocation is a rare but potentially life-threatening injury due to its proximity to critical mediastinal structures. Early diagnosis and prompt management are essential to prevent severe complications such as vascular or respiratory compromise. We report a case of a 23-year-old male who presented to our emergency department five days after a high-energy motor vehicle accident with isolated, closed posterior dislocation of the SCJ. The patient complained of left shoulder pain, mild dysphagia, and intermittent tingling in the left upper limb. Imaging revealed a posterior SCJ dislocation with minimal compression of the left brachiocephalic vein but no vascular injury. Closed reduction under general anesthesia was successfully performed using a towel clamp for manipulation. Stability was confirmed intraoperatively with fluoroscopy, and the patient was discharged 24 hours post procedure. Follow-up at two weeks and two months showed maintained reduction, resolution of symptoms, and full range of motion. In conclusion, posterior SCJ dislocations, while uncommon, require a high index of suspicion due to their potential for severe complications. Closed reduction remains a feasible treatment option even in delayed presentations up to five days post injury. The involvement of a multidisciplinary team is crucial during the management of these injuries to ensure comprehensive care and mitigate the risks associated with potential complications.

Keywords: dislocation; posterior sternoclavicular joint dislocation; sternoclavicular; sternoclavicular joint; sternoclavicular joint dislocation.

Figure 1. Axial chest CT angiography showing posterior dislocation of the left sternoclavicular joint.

Figure 2. Anteroposterior-angled cephalic 20-degree X-ray of the bilateral clavicle done three months postoperatively showed reduced and symmetrical sternoclavicular joint.