Resection arthroplasty of the sternoclavicular joint

Department of Orthopaedics, The University of Texas Medical School at San Antonio, 78284-7774, USA.
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 04/1997; 79(3):387-93.
Source: PubMed


The results of resection of the medial end of the clavicle to treat a painful sternoclavicular joint in fifteen patients were retrospectively reviewed. The patients fell into two groups: eight patients who had had a primary arthroplasty of the sternoclavicular joint in which the costoclavicular ligament was left intact (group I), and seven patients who had had revision of a failed arthroplasty of the sternoclavicular joint and in whom the costoclavicular ligament had to be reconstructed (group II). The results for these two groups were compared at an average of 7.7 years postoperatively. All eight patients in group I had an excellent result. In sharp contrast, three patients in group II had an excellent result, three had a fair result, and one had a poor result. We conclude that preservation or reconstruction of the costoclavicular ligament is essential at the time of resection of the medial portion of the clavicle in order to obtain a satisfactory result.

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    • "L'indication chirurgicale est retenue devant la présence d'une menace cutanée, d'une douleur ou d'une gêne fonctionnelle persistante et invalidante [2]. De nombreuses techniques chirurgicales stabilisatrices ont été décrites : • la ligamentoplastie costoclaviculaire et/ou sternoclaviculaire utilisant le tendon du sous-clavier [17], une bandelette tendinopériostée du sternocléidomastoïdien [18] ou le fascia lata [19] visent à renforcer le ligament costoclaviculaire ; • la double suture aux fils ou à l'aide du semi-tendineux ou du gracile [20] entre l'extrémité médiale de la clavicule et le manubrium , passée au travers de la corticale externe des 2 os permet de renforcer les structures capsuloligamentaires antérieures [21] ; • la résection arthroplastie de l'extrémité médiale de la clavicule avec stabilisation par passage intramédullaire des ligaments [22] avec ou sans attachement à la 1 re côte [23] est une technique plus agressive mais utile en cas de luxation difficilement réductible ou de délabrement fracturaire de l'extrémité médiale ; • la fixation complémentaire de l'articulation sternoclaviculaire par broches de Kirschner peut permettre la cicatrisation d'une plastie [24]. La majorité des auteurs ne recommandent pas l'emploi de broches de Kirschner ou de tout autre type de fixation métallique, compte tenu des complications potentiellement dramatiques consécutives aux migrations. "
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    ABSTRACT: Sternoclavicular joint dislocations are rare and generally occur in young adults as a consequence of a high-energy trauma. In this article, the authors review the epidemiology, the physiopathology, the clinical presentation, the radiology, and the treatment of acute sternoclavicular joint dislocations. Chronic instability is not discussed.
    Full-text · Article · Apr 2015 · Revue du Rhumatisme Monographies
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    • "Many techniques of sternoclavicular stabilization have been described: soft-tissue reconstruction [5] [8] [9] [6], plate fixation [2] [34] [19] [39] [21], suture anchors [1]. Resection of the medial clavicle was described to treat chronic painful SCJ dislocation with degenerative lesions as seen in our case [36] [17]. Fixation with K-wires is not recommended because of the potential risk of migration towards vital structures [10] [3] [41] [27]. "
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    ABSTRACT: The posterior variety of sternoclavicular joint dislocation is an uncommon condition accounting for 0.06% of all shoulder injuries, the diagnosis is often missed, but frequently associated to a high morbidity by compromising the great vessels, trachea, oesophagus, or lungs. Although the majority of these complications are observed in acute presentation, few reports noted late complications with chronic unreduced dislocation. We describe a 26-year-old man, with chronic posterior sternoclavicular joint dislocation; the diagnosis was made 6 months after the injury when the dislocation was causing subclavian vein compression, treatment consisted of an excision of the medial end of the clavicle and costoclavicular stabilization with sterno-cleido-mastoid tendon. At 6 months’ follow-up, the patient felt well and had returned to work with slight restriction and intermittent use of non steroidal anti-inflammatory medication. This report shows clearly the possibility of serious complications in a chronic unreduced posterior sternoclavicular dislocation and highlights the importance to recognize and reduce at its initial presentation. The urgent CT scan is the best method for diagnosis and should be obtained when this injury is suspected.
    Full-text · Article · Mar 2013 · Injury Extra
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    • ".). Among the most commonly used techniques, that of Jackson Burrows using the subclavious muscle tendon or those performing temporary joint fixation by means of internal fixation devices such as osteosutures, cerclage wirings or cannulated screws) [3] [17] [18]. "
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    ABSTRACT: Proximal physeal fracture-separation of the clavicle is a very rare injury occurring in the adolescent and in the young adult which involves a contact loss with fracture between the clavicle and its cartilaginous ossification center similar in appearance to a sternoclavicular dislocation. The authors report an unusual case of a proximal physeal fracture-separation of the clavicle with avulsion of sternoclavicular periosteal and ligamentous structures without vasculonervous injury in a 16-year-old young person. A CT scan examination is essential. Surgical management consisted in costoclavicular ligament and periosteum reattachment associated with reduction of the fracture-separation and pin fixation.This repair demonstrated a successful outcome at 8-month follow-up.
    Preview · Article · Mar 2011 · Orthopaedics & Traumatology Surgery & Research
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