Acute dislocations of the sternoclavicular joint: treatment and outcomes

Abstract

Objectives: Identify treatment and describe outcomes and complications of acute anterior and posterior sternoclavicular joint dislocation.

Design: Retrospective case series.

Setting: Twelve level-one trauma centers.

Patient/participants: One hundred twenty-five patients with acute sternoclavicular joint dislocation, most were male (67%), White (61%), 18-29 years old (57%), involved in a motorized collision (60%), with anterior (35%) or posterior (65%) sternoclavicular joint dislocation treated by operative or nonoperative technique.

Main outcome measurements: Outcomes and complications of joint instability, post-traumatic arthritis, neurovascular injury, chronic pain, and cosmetic deformities after operative and nonoperative treatment of anterior and posterior acute sternoclavicular joint dislocation are reported.

Results: Thiry-nine (48%) posterior dislocations received surgery as initial management, whereas 5/44 (11%) of the anterior dislocations received acute surgery. The most common fixation techniques included suture fixation repair (39%), plate fixation (30%), percutaneous reduction (18%), and graft reconstruction (9%). Fifty-four (43%) patients from the entire cohort had complications after initial treatment. Eighteen complications occurred among the operative group (41%) and 36 in the nonoperative group (44%). The most common complications were pain (20%), decreased range of motion (14%), and joint instability (10%) requiring secondary fixation.

Conclusion: Both operative and nonoperative management of sternoclavicular joint dislocations had a high rate of complications among anterior and posterior joint dislocations. However, a similar incidence of complications and outcomes occurred comparing anterior or posterior injuries with or without operative treatment. Therefore, clinicians need to evaluate each patient individually taking into account, patient factors, injuries, symptoms, and risks to determine if surgery is required.

Level of evidence: Therapeutic Level III.

Keywords: dislocation; nonoperative; operative; sternoclavicular; treatment.