[The sternoclavicular luxation].

INTRODUCTION

Injuries of the sternoclavicular joint are rare. Probably these injuries are frequently missed. Distorsion type lesions mostly heal uneventfully. Their diagnosis and treatment may be demanding. Untreated, a dislocation of the sternoclavicular joint and dislocation fractures may lead to considerable discomfort or even a risk for neurovascular damage. This work focuses on the anatomy and lesions of the sternoclavicular joint, the pathomechanism of the injury and the treatment options according to our acute trauma-patient collective.

METHOD: Five patients with sternoclavicular impairment have been assessed. Radiological evaluation consisted in standard chest X-rays. In the situation of a fracture and/or complete luxation, CT scans of the sternoclavicular joints were additionally performed. Two of our patients underwent surgery (one osteosynthesis with a plate and one reduction and ligament reconstruction were performed), in one case dislocation was reduced in a closed way in a short-lasting general anaesthesia and in two cases conservative treatment was performed.

RESULTS

In all cases the chosen treatment protocol led to symmetrical arm function and all patients were pain-free 2 to 6 months after the injury. In one patient the plate was removed 4 months after osteosynthesis.

CONCLUSION

Distorsions of the sternoclavicular joints are probably underdiagnosed and often mildly symptomatic. Conservative treatment usually leads to satisfying functional results with significant pain reduction. Non-reducible dislocations and dislocation fractures have to be treated operatively. Many different open procedures have been described, such as ligament reconstructions and osteosynthesis. The postoperative results are generally good, but operative treatment may be difficult and at risk for complications. Indications for operative treatment of joint subluxation should be strictly limited because of the high risk of accompanying neurovascular impairment during manipulation and fixation.