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Injuries to the sternoclavicular (SC) joint are rare, however, when they occur prompt recognition, evaluation, and treatment are crucial. SC joint injuries can occur following high-energy mechanisms such as motor vehicle collisions and contact sports. Injury to the SC joint can be evaluated with the use of plain radiographs as well as computed tomography. If an injury to the SC joint is suspected, injury to vital mediastinal structures must be evaluated. SC joint dislocations can be treated by either closed reduction or open reduction and stabilization. Many stabilization methods have been described including plate stabilization and ligament reconstruction. [ABSTRACT FROM AUTHOR]

The sternoclavicular joint is the only true joint connecting the upper limb with the axial skeleton and is reliant on its capsular and ligamentous attachments for stability. Injuries to the sternoclavicular joint are uncommon and include sprains, dislocations, and fractures. Dislocations and medial clavicle fractures are often associated with high-energy trauma and can lead to life-threatening complications secondary to mediastinal injuries, particularly with posterior sternoclavicular joint dislocations. Given the rarity of these injuries, there are multiple case reports and retrospective studies detailing novel surgical techniques for managing injuries of the sternoclavicular joint and no single option has been implemented. We conducted a literature search on Medline, EMBASE and CINAHL to identify relevant articles focusing on sternoclavicular joint dislocation and subluxation, and medial clavicle fractures in adults. This review article aims to describe: the anatomy of the sternoclavicular joint; injuries including dislocation and medial clavicle fractures; and current investigation and management options including closed and open reduction techniques. [ABSTRACT FROM AUTHOR]

Posterior sternoclavicular joint dislocation is a rare condition. In this paper, we present a 51-year-old male patient who was admitted to the emergency department in our hospital after he was hit by a mining railway wagon in the chest. A diagnosis of posterior sternoclavicular dislocation was confirmed after performing a CT scan. Following necessary preparations, the sternoclavicular joint was stabilized with two wire cerclage techniques during open reduction. During control at the postoperative 4th week, the range of motion at the shoulder was satisfactory, but the patient had mild pain at the joint level and was sent to physical therapy to improve the range of motion and to minimize the pain. [ABSTRACT FROM AUTHOR]

Sternoclavicular joint (SCJ) pathologies such as instability are rare; therefore, SCJ surgery is performed infrequently. Complications of these surgeries can be devastating. This study evaluated complications, and particularly infections, after SCJ surgery. A retrospective cohort of 68 patients who underwent SCJ surgery with a minimum follow-up of 1 year was reviewed. Patients' characteristics, intraoperative, and postoperative complications were retrieved. In case of a reoperation, relevant data from the reoperation and microbiological findings were collected. Twenty-two men and 46 women with a mean age of 37.5 years (range, 13-70 years) were analyzed. A complication occurred in 26 of 68 patients (38.2%). In 16 patients (23.5%), this was an infection. Cutibacterium acnes was the pathogen in 14 of these infections. Infection occurred more often in men than in women (P =.02). A total of 26 reoperations were performed in our cohort: 14 due to clinical signs of infection, 9 due to instability, 1 due to complaints of SCJ osteoarthritis, and 2 due to other causes. Complications after SCJ surgery occur more often than previously described. C. acnes infections are often seen. When left untreated, these complications can lead to persistent complaints or recurrent instability due to failure of reconstruction. Therefore, it is of utmost importance to identify infections at an early stage, or better, to prevent them. The use of benzoyl peroxide gel preoperatively seems effective in reducing early C. acnes infections in this type of surgery. [ABSTRACT FROM AUTHOR]

The manubrium stabilizes the shoulders and assists in movement of the chest wall during respiration. Thus, resection of the manubrium creates instability of the chest wall and exposes the underlying great vessels. The material utilized to reconstruct the manubrium should be durable, resistant to infection and rejection, and provide good cosmesis. Autologous iliac crest bone grafts have been successfully used for bone replacement by orthopaedic surgeons and have proven to be versatile and less prone to rejection. In this article, we describe our technique for reconstruction of the sternum utilizing iliac wing bone autograft. [ABSTRACT FROM AUTHOR]

• Surgical intervention is indicated in cases of SCJ osteomyelitis after failure of conservative management. It provide definitive management when the joint shows signs of destruction in CT scan. • SCJ debridement followed by delayed resection of the joint together with the surrounding infected tissue including bone and cartilages, offer better results than merely debridement alone. • Pectoralis muscle flap achieves best result in the management of sternoclavicular joint osteomyelitis after resection of the joint. Sternoclavicular joint (SCJ) osteomyelitis is a very rare condition. Here, we report an uncommon case of a complicated SCJ osteomyelitis in a patient with an anterior chest wall trauma. A 61-year-old male a known case of dyslipidemia, hypertension (HTN), and type II diabetes mellitus (T2DM). The patient presented with pain and erythema over the right SCJ following trauma to the same location. Two weeks later, the patient presented with erythematous swelling with a sinus discharging pus, although he was discharged on oral antibiotics, analgesics, and had underwent an incisional drainage. Computerized Tomography (CT) of the chest showed fluid collection surrounding the right SCJ together with joint effusion suggestive of SCJ osteomyelitis. The patient underwent initial debridement and a definitive bone resection with pectoralis muscle flap two weeks following. Five months later, the patient was seen in the outpatient clinic, the wound was completely healed, and he has a normal function of the right arm. The management of SCJ osteomyelitis is not well established, yet it can be approached medically, surgically, or both. Surgical intervention is indicated in cases of SCJ osteomyelitis after the failure of antibiotic therapy trial. This is especially the case in the presence of abscess and bone destruction. SCJ debridement followed by delayed resection and pectoralis muscle flap might offer better results than merely debridement alone or with resection of the joint. [ABSTRACT FROM AUTHOR]

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Sternoclavicular joint tuberculosis is rare with non-specific signs and symptoms thus making correct clinical diagnosis difficult. Delay in diagnosis results in destruction of osteo-ligamentous structures, spread of abscess to deeper planes as well as bursting through skin resulting in joint instability and scar formation. All the cases of sternoclavicular joint tuberculosis presented to the orthopaedic outdoor between 2004 and 2017 were evaluated clinico-radiologically along with cyto-histopathological and/or microbiological tests to ascertain the diagnosis before initiation of treatment. There were 11 males and 5 females patients aged 11–65 years (mean, 35 years). Aspiration or curettage of the swelling was performed, and the diagnosis was confirmed in 12 cases by cytology, AFB stain, TB polymerase chain reaction, culture or a combination of these. In 4 patients, anti-tubercular treatment was initiated on clinical suspicion. Diagnosing sternoclavicular tuberculosis requires multimodal approach. A strong clinical suspicion is required as the presentation is often atypical. Early detection of disease and with conservative treatment resulted in complete remission and minimal long term disability. [ABSTRACT FROM AUTHOR]

Sternoclavicular joint (SCJ) infection is a rare disease and its management remains controversial. Our institution has adopted an aggressive surgical approach of radical SCJ resection combined with myocutaneous flap (MCF) closure whenever possible. We reviewed our experience with this approach in the management of this condition. From July 2004 to June 2018, 50 consecutive patients were treated surgically for SCJ infections. Patient demographics, imaging studies, microbiology, and operative variables were analyzed. All patients underwent ipsilateral SCJ resection. Wound closure was performed with primary pectoralis advancement MCF closure at the initial operation in 25 patients, delayed MCF closure following temporary wound vacuum therapy and redebridement in 19 patients, and definitive wound vacuum therapy (DWVT) in 6 patients. End points were recurrence of infection, perioperative morbidity, and mortality. Localized swelling (100%) and pain (100%) were the most common presenting symptoms. MSSA was isolated in 50% of tissue cultures. Comorbidities included tobacco smoking 52%, diabetes mellitus 50%, intravenous drug use 34%, poor dental hygiene 32%, and obesity 28%. We had no deaths within 90 days of operation. Complications; seroma in 1 patient (2%), chest wall hernia in 1 patient (2%), retained drains in 1 patient (2%), recurrent osteomyelitis infection in 3 patients (6%), and hematomas in 5 patients (10%). Patients treated with primary MCF closure at the initial operation had a 0% (0/25) rate of recurrence compared to 5.26% (1/19) in delayed MCF closure. Overall, there was only a 2.27% (1/44) recurrence of infection in primary and delayed MCF closure combined, compared to 33.33% (2/6) in patients treated with DWVT closure. SCJ infections require an aggressive approach. Wound closure with an MCF (primary or delayed) is associated with less recurrence of infections compared with DWVT closure. Radical resection of the entire SCJ with MCF (primary or delayed) should be considered the preferred management strategy in patients with SCJ infections. [ABSTRACT FROM AUTHOR]

Atraumatic sternoclavicular dislocation (ASCD) is an uncommon pathology that is mainly diagnosed in young adults. The aim of this study is to better describe the clinical picture of ASCD and to describe the results of a "wait-and-see" policy in these patients. All patients with ASCD who visited our department between 2011 and 2016 were retrospectively analyzed. A standardized clinical examination was used to evaluate the clinical picture. All patients were treated nonoperatively, and at latest follow-up, several parameters and standardized questionnaires (Nottingham Clavicle Score, Oxford Shoulder Score, Constant-Murley Score) were used to evaluate the outcome. In total, 23 patients (12 male, 11 female) were evaluated. The average age at diagnosis was 18.6 years. There was a significant difference (P <.001) in angle of dislocation during forward flexion (mean = 141°) compared with abduction (mean = 101°). At latest follow-up (average 46 months, range 14-113 months; standard deviation [SD] = 27), subluxations still occurred but were less frequent and less prominent relative to presentation at initial diagnosis in 19 of 23 patients. The chance of subjective improvement increased by 27% for each year of follow-up. High outcome scores of Nottingham Clavicle Score (mean score = 80, SD = 11), Oxford Shoulder Score (mean score = 44, SD = 4), and Constant-Murley Score (mean score = 83, SD = 11) were reported. In patients with ASCD, the clavicle subluxates earlier in abduction than in forward flexion. After a midterm follow-up, a "wait-and-see" policy does not resolve the subluxations. However, most patients displayed reduced frequency and severity of subluxations over their recovery period and showed excellent scores on shoulder questionnaires. [ABSTRACT FROM AUTHOR]

Sports-related injuries to the shoulder are common causes of disability. Injuries to the sternoclavicular joint (SCJ) in sports are more rare, though have been reported in a small number of cases. SCJ injury classification is determined by the degree of joint displacement and direction of clavicular displacement. Direction of displacement is particularly important due to risk of injury to intrathoracic structures, which has the potential to result in fatal outcomes. These injuries are important to identify in athletes and can be difficult to assess on the field. Specific radiographic views and use of ultrasound can improve accuracy of diagnosis. Reduction of acute traumatic SCJ dislocations is recommended and may require open reduction in the case of posteriorly displaced dislocations. Surgical treatment is indicated in cases of persistent pain or significant compression to intrathoracic soft tissue structures. Long-term outcomes are generally favorable, and athletes are able to return to sport without functional limitations. [ABSTRACT FROM AUTHOR]

Background This study assessed whether treating medial end clavicular fractures using an inverted distal clavicle locking plate, twisted through 90° around its axis, would allow for a less invasive surgical approach and improve screw trajectory insertion. Materials and methods We searched the databases of the 2 senior authors for patients who had sustained an acute, displaced fracture of the medial end of the clavicle and had undergone operative fixation using an inverted distal clavicle plate contoured through 90°. Through an inferior incision, a contoured locking plate was positioned on the anterior surface of the medial end of the clavicle. Up to 8 unicortical screws were inserted from anterior to posterior through the medial end of the plate. The lateral end was contoured and fixed to the superior clavicular surface. The patients were assessed preoperatively and at 1 month, 4 months, and final follow-up. Preoperative and postoperative plain x-ray images and computed tomography scans were reviewed. Results The study included 8 patients (average age, 31.3 years; range, 15-59 years) with displaced fractures who underwent fixation. The median follow-up time was 30.5 months (range, 24-45 months). All patients reached clinical and radiographic union at 4 months. The mean 11-item version of the Disabilities of the Arm, Shoulder, and Hand score was 0.6 (range, 0-2.3). All of the patients had returned to their preinjury level of sport and activity. None of the patients had a complication. Conclusion Contouring an inverted distal clavicle plate through 90° may improve fixation options by allowing access to the anterior clavicle when treating medial clavicular fractures. [ABSTRACT FROM AUTHOR]

Background Chronic anterior sternoclavicular (SC) instability is a rare but potentially disabling condition. It can arise in conjunction with trauma or hyperlaxity, or both. Numerous surgical techniques have been described, but no gold standard exists. SC instability is often position-dependent and can be reduced with the arm in a specific position. Methods To directly address this issue, we used a technique of corrective osteotomy of the clavicle with the goal to reorient the articular portion of the medial end of the clavicle so that it remains stable in all functional positions of the arm. To illustrate the technique and the correction in space, we performed postoperative 3-dimensional computed tomography analyses of the shoulder girdle of 4 patients. Clinical scores were obtained at the final follow-up and compared with preoperative scores. Results Mean follow-up was 64 months (range, 19-191 months). The mean Constant score improved from 58 (range, 45-68) preoperatively to 73 (range, 69-84) postoperatively and the Subjective Shoulder Value from 42 (range, 15-80) to 79 (range, 50-100). All patients reported good or very good stability of the SC joint at the last follow-up. We recorded no intraoperative or direct postoperative complications. During follow-up, 3 patients underwent removal of the plate, 1 of them for plate breakage. The mean postoperative correction for combined rotations is given as a 3-dimensional angle and averaged 28.0° (range, 8.6°-39.7°). Conclusion In this pilot study, medial corrective clavicular osteotomy using the described technique treated anterior SC instability with improvement of clinical shoulder function scores and good patient satisfaction. The technique appears simple and safe and deserves further evaluation. [ABSTRACT FROM AUTHOR]

Abstract Introduction Infections of the sternoclavicular joint (SCJ) account for less than 1% of all joint infections. There are no standardized diagnostic and therapeutic algorithms defined in literature. This study intended to report the risk factors, the bacterial spectrum, the extent and localization and the clinical outcome of SCJ infections. Patients and methods We retrospectively reviewed the medical charts of 13 patients (8 men, five women, mean age 37.6 years) with SCJ infections between Januray 1st 2008 and October 30th 2015 for clinical parameters and radiological studies. All patients were interviewed during their follow-up along with clinical examination and assessing the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Results Nine patients presented with local chest pain and swelling; in 4 patients, the prevalent symptom was pain without local signs of inflammation. Full blood count revealed a mean leukocytosis of 15 × 109 L and a mean CRP of 21.0 mg/dl. Approximately 61.5% reported known diabetes mellitus. 10 patients presented an involvement of surrounding structures. All patients received a preoperativ CT scan. Each patient was treated via SCJ resection without intraoperative complications. Primary wound closure was possible in all cases. The mean follow-up was 95 days. Wound culture revealed Staphylococcus aureus in all patients. Pathological examination affirmed acute osteomyelitis in 7 patients. Four patients required the intensive care of which 2 patients died from septic shock. Recurrent infection was encountered in 3 patients who underwent revision surgery. Mean DASH Score was 18.7. Conclusion CT should be routinely obtained to recognize the possible extends to the surrounding structures. SCJ resection can result in satisfactory clinical results and should be considered in cases of extended infections including the surrounding structures. Empiric antibiotic coverage should contain cephalosporin or extended-spectrum penicillin. Inappropriate or less-invasive surgical procedures may cause recurrencent infections, especially in cases of osteomyelitis. [ABSTRACT FROM AUTHOR]

Abstract An evaluation of the method used to diagnose sternoclavicular joint (SCJ) osteoarthritis (OA) in skeletal remains is presented, with particular attention given to the anatomy of the joint. The current palaeopathological diagnostic criteria used to identify SCJ OA were found to be appropriate for both the sternal and clavicular surfaces of the SCJ, with eburnation indicating perforation of the intra-articular disc and advanced disease. Eburnation was found to occur rarely in the SCJ, and if used as the sole diagnostic criterion would result in an underestimation of SCJ OA prevalence in archaeological assemblages. A key finding was the identification of changes characteristic of OA but confined to the attachment zone of the intra-articular disc on the clavicular surface of the SCJ. As this area of the joint is non-articular, and not normally covered with articular cartilage, a diagnosis of OA would be inaccurate and instead it should be considered as an enthesopathy. It is likely that SCJ OA has been incorrectly identified and over-diagnosed in the archaeological record in the past. More histological research into the disc attachment and its degeneration is required before this can be confirmed. [ABSTRACT FROM AUTHOR]

Chondrocalcinosis is a metabolic arthropathy rarely affecting the anterior chest wall (ACW). To report here a case of a polyarticular chondrocalcinosis with an uncommon localization in the sternoclavicular joints (SCJs), revealed by computed tomography (CT). A 76-year old female presented to the Rheumatology outpatient clinic Kassab orthopedics institute with low back pain. The history goes back to 4 months prior to her presentation when she developed mechanical back pain that progressively worsened during the last month, becoming inflammatory with prolonged morning stiffness. She had no history of fever or weight loss and no symptoms in the cervical spine, shoulders, chest wall, hips or knees. Physical examination revealed limited range of motion of hips, cervical and lumbar spine and bilateral swelling of SCJs without tenderness on pressure or mobilization. Biochemical investigations showed normal levels of inflammatory markers, phosphorus and calcium. Conventional radiographs showed multiple areas of calcification in the intra-vertebral discs, joint space narrowing of sacroiliac (SI) and coxofemoral joints. Chest wall radiograph appeared normal. ACW and pelvic CT were done to further delineate the cause. It showed intra-cartilaginous bilateral calcifications of SCJs, sacroilliac, intervertebral discs, coxofemoral joints and pubic symphysis. The final diagnosis was polyarticular chondrocalcinosis. The patient received analgesics, non-steroidal anti-inflammatory drugs and had functional rehabilitation sessions. Conclusion: This case points to the rare localization of chondrocalcinosis in the SCJ and should be considered especially in an elderly female. Early recognition is necessary in order to initiate an appropriate and prompt treatment. [ABSTRACT FROM AUTHOR]

Background: Sternoclavicular (SC) joint instability is a rare injury, but one with profound implications given its proximity to vital structures and function as the only true articulation between the upper extremity and axial skeleton. The majority of SC joint instability can be treated non-operatively; however, there is a role for reconstruction in the presence of instability that results in pain and dysfunction that is refractory to conservative management or deformity resulting in functional impairment. Given the lack of inherent osseous stability at the sternoclavicular joint and the role of ligaments as primary stabilizers, surgical inter-vention with emphasis on ligament reconstruction may be recommended. Safe and effective rehabilitation is conducted through phase progression, with avoidance of premature stress to the healing soft tissue graft. The purpose of this clinical commentary is to provide the senior author's rehabilitation protocol, which utilizes the available scientific literature to inform phase content and progression. Level of Evidence: 5 [ABSTRACT FROM AUTHOR]

The sternoclavicular joint is, in the main, a stable joint which relatively rarely becomes diseased. However, conditions of the sternoclavicular joint, when untreated, can have major life limiting consequences. They therefore merit serious consideration because they are rare and an individual clinicians' experience will inevitably be limited. This article covers the main conditions of the sternoclavicular joint: dislocations; periarticular fractures of the clavicle in children and adults; swellings, which may be arthritis, infection, or tumours, and rare conditions. The article focusses on how to diagnose and treat these disorders, what to watch out for in clinical practice and how to manage the late diagnosis. [ABSTRACT FROM AUTHOR]

Background Patients with acromioclavicular joint (ACJ) and sternoclavicular joint (SCJ) injuries and with clavicle fractures are typically younger and more active than those with other shoulder pathologies. We developed the Nottingham Clavicle Score (NCS) specifically for this group of patients to improve sensitivity for assessing the outcomes of treatment of these conditions compared with the more commonly used Constant Score (CS) and Oxford Shoulder Score (OSS). Materials and methods This was a cohort study in which the preoperative and 6-month postoperative NCS evaluations of outcome in 90 patients were compared with the CS, OSS, Imatani Score (IS), and the EQ-5D scores. Reliability was assessed using the Cronbach α. Reproducibility of the NCS was assessed using the test/retest method. Effect sizes were calculated for each score to assess sensitivity to change. Validity was examined by correlations between the NCS and the CS, OSS, IS, and EQ-5D scores obtained preoperatively and postoperatively. Results Significant correlations were demonstrated preoperatively with the OSS ( P  = .025) and all subcategories of the EQ-5D ( P  < .05) and postoperatively with the OSS ( P  < .001), CS ( P  = .008), IS ( P  < .001), and all subcategories of EQ-5D ( P  < .02). The NCS had the largest effect size (1.92) of the compared scores. Internal consistency was excellent (Cronbach α = 0.87). Conclusion The NCS has been proven to be a valid, reliable and sensitive outcome measure that accurately measures the level of function and disability in the ACJ, SCJ and clavicle after traumatic injury and in degenerative disease. [ABSTRACT FROM AUTHOR]

Background For many years, researchers have attempted to describe shoulder motions by using different mathematical methods. The aim of this study was to describe a procedure to quantify clavicular motion. Methods The procedure proposed for the kinematic analysis consists of 4 main processes: 3 transcortical pins in the clavicle, motion capture, obtaining 3-dimensional bone models, and data processing. Results Clavicular motion by abduction (30° to 150°) and flexion (55° to 165°) were characterized by an increment of retraction of 27° to 33°, elevation of 25° to 28°, and posterior rotation of 14° to 15°, respectively. In circumduction, clavicular movement described an ellipse, which was reflected by retraction and elevation. Kinematic analysis shows that the articular surfaces move by simultaneously rolling and sliding on the convex surface of the sternum for the 3 movements of abduction, flexion, and circumduction. Conclusion The use of 3 body landmarks in the clavicle and the direct measurement of bone allowed description of the osteokinematic and arthrokinematic movement of the clavicle. [ABSTRACT FROM AUTHOR]

Purpose Originally introduced for mandibular reconstruction more than 40 years ago, the sternoclavicular graft (SCG) has gained widespread popularity for the reconstruction of the ramus-condyle unit (RCU) owing to its anatomic and histological likeness to the normal mandibular condyle. Conventional longitudinal osteotomy design for its harvest has been fraught with considerable complications at the donor site including fracture clavicle and major neurovascular injury. In an attempt to alleviate these ill effects, a new technique for procuring the sternoclavicular graft is presented. Material and methods A split-thickness cortico-cancellous graft was harvested form the sternal end of the clavicle along with the articular disk with the osteotomy cut oriented parallel to the coronal plane, with limited soft tissue dissection. Donor site complications were assessed in terms of incidence of clavicle fracture, neurovascular injury, pleural tear and radiographic healing as seen in the six-month postoperative chest radiograph. Results 17 patients suffering from unilateral temporomandibular joint ankylosis underwent SCG harvesting for RCU reconstruction following osteoarthrectomy. No adverse events were seen in the intra- and post-operative period in any patient and satisfactory radiographic osseous healing was observed after six months. Conclusion The proposed harvest technique for SCG results in reduced donor site morbidity and favourable healing and greater patient comfort. [ABSTRACT FROM AUTHOR]

Background Instability of the sternoclavicular (SC) joint is a rare condition. However, in some cases, SC joint instability may lead to persistent pain and impairment of shoulder function that requires surgical management. This study evaluated clinical outcomes after SC joint reconstruction with hamstring tendon autograft in patients with SC joint instability. Methods From December 2010 to January 2014, 21 reconstructions of the SC joint with hamstring tendon autograft were performed. Outcomes data were prospectively collected and retrospectively reviewed. Data analyzed included American Shoulder and Elbow Surgeons score, Quick Disability of the Arm, Shoulder and Hand, physical component of the Short Form 12, and Single Assessment Numeric Evaluation scores. Pain with activities of daily living, work, and sleep were separately analyzed along with painless use of arm for activities. Patients were also questioned regarding postoperative satisfaction. Results Nine women and 10 men (2 bilaterals), with a mean age of 30 years (range, 15-56 years), were monitored for a mean of 2 years (range, 12-36 months) postoperatively. Mean American Shoulder and Elbow Surgeons, Quick Disability of the Arm, Shoulder and Hand, and Single Assessment Numeric Evaluation scores significantly improved ( P < .001). Pain scores also improved over preoperative baselines, including pain with activities of daily living, work, and sleep ( P < .001). Median satisfaction at final follow-up was 8.5 (range, 7-10). There were no intraoperative or postoperative complications and no cases of recurrent instability. Conclusion Free hamstring tendon autograft reconstruction for SC joint instability resulted in significantly improved clinical outcomes with high patient satisfaction and no intraoperative or postoperative complications. [ABSTRACT FROM AUTHOR]

Copyright of China Journal of Oral & Maxillofacial Surgery is the property of Shanghai Jiao Tong University, College of Stomatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Posterior dislocation of the sterno-clavicular (SC) joint is a rare injury in athletes. It normally occurs in high collision sports such as American football or rugby. Acute posterior dislocations of the SC joint can be life-threatening as the posteriorly displaced clavicle can cause damage to vital vascular and respiratory structures such as the aortic arch, the carotid and subclavian arteries, and the trachea. The potential severity of a posterior SC joint dislocation provides multiple challenges for clinicians involved in the emergency care and treatment of this condition. Integration of clinical examination observations, rapid critical thinking, and appropriate diagnostic imaging are often required to provide the best management and outcome for the injured athlete. The criterion for return-to-play and participation in collision sports after suffering a posterior dislocation of the SC joint are unclear due to the rarity of this injury. The purpose of this case report is to describe the management, from the initial on-field evaluation through the return-to-sport, of a collegiate Division I football player following a traumatic sports-related posterior SC joint dislocation. The rehabilitation process and the progression to return to participation are also presented and briefly discussed. [ABSTRACT FROM AUTHOR]

Background Sternoclavicular joint (SCJ) instability is a rare condition resulting in impaired function and shoulder girdle pain. Various methods for stabilizing the SCJ have been proposed, with biomechanical analysis demonstrating superior stiffness and peak load properties with a figure-of-8 tendon graft technique. The purpose of this study was to evaluate the clinical outcomes of SCJ reconstruction with an interference screw figure-of-8 allograft tendon technique. Methods A retrospective analysis of a consecutive cohort of patients from 2007 to 2011 was performed for all patients undergoing SCJ reconstruction for instability. All patients were treated for SCJ instability with a figure-of-8 allograft reconstruction augmented by 2 tenodesis screws. Outcomes were performed with the American Shoulder and Elbow Surgeons (ASES) score, the shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and the visual analog scale (VAS) for pain score for all patients. Intraoperative and postoperative complications were recorded. Results A total of 10 patients were included in the study, with an average follow-up of 38 months (range, 11.6-66.8 months). Preoperatively, the mean ASES score was 35.3 points (range, 21.7-55 points), whereas the postoperative mean ASES score increased to 84.7 points (range, 66.6-95 points). The mean VAS score improved from 7.0 (range, 5-10) before surgery to 1.15 (range, 0-3) at follow-up, and the QuickDASH score average was 17.0 points (range, 0 to 38.6 points). Minor postoperative complications were noted in 2 patients. Conclusion Patients who underwent repair of SCJ instability by an augmented figure-of-8 allograft tendon reconstruction report marked improvements in both shoulder function and pain relief. [ABSTRACT FROM AUTHOR]

The sternoclavicular joint (SCJ) has similar anatomical and physical characteristics to the temporomandibular joint (TMJ). The purpose of this article is to introduce a modified technique for the pedicled SCJ and the expanded indications for its use. During the period June 2011 to June 2014, six TMJs were reconstructed using the superior half of the SCJ pedicled with the sternocleidomastoid muscle. The inclusion criteria were (1) poor vascularization jeopardizing a non-vascularized TMJ replacement, and/or (2) a large defect of both bone and soft tissue. The average follow-up period was 14.8 months (range 7–39 months). Fracture of the clavicle occurred in one patient (16.7%). No recurrence, graft resorption, or secondary deformity was found. Reconstruction of the TMJ using the superior half of the SCJ pedicled with the clavicle head of the sternocleidomastoid muscle and sternocleidomastoid branch of the superior thyroid artery benefited patients who had a poor blood supply and a medullary condition or who had a defect in both the condyle and surrounding soft tissue. [ABSTRACT FROM AUTHOR]

Résumé Les articulations de la paroi thoracique antérieure peuvent être affectées par divers processus pathologiques. Les arthropathies inflammatoires des articulations sternoclaviculaire et manubriosternale sont fréquentes et doivent être différenciées de l’arthrose et l’arthrite septique. Les atteintes radiologiques de la polyarthrite rhumatoïde sont peu spécifiques : érosion, déminéralisation et synovite. Érosions, hyperostose modérée et ankylose partielle ou complète des articulations ont été observées dans la spondylarthrite ankylosante, les arthrites réactionnelles et le psoriasis. Hyperostose et ostéosclérose étendue sont caractéristiques du SAPHO. L’hyperfixation en « tête de taureau » (du manubrium sternal et les deux articulations sternoclaviculaires) est aussi très spécifique du diagnostic de SAPHO et peut éviter la biopsie. Sternoclavicular joints, critical structures of the anterior chest wall, may be affected by various pathologic processes. Inflammatory arthropathies of the sternoclavicular and manubriosternal joints are common and must be differentiated from osteoarthritis and septic arthritis. Radiological changes of rheumatoid arthritis include erosion and indistinct cortical margins. Erosions, slight or moderate hyperostosis and partial or complete fusion of the joint have been observed in ankylosing spondylitis, reactive arthritis (Reiter syndrome), and psoriatic arthritis. Hyperostosis and osteosclerosis are characteristic findings of SAPHO. Other findings include joint erosion and ankylosis. The “bull's head” sign (increased radiotracer uptake in the sternal manubrium and both sternoclavicular joints at delayed scintigraphy) is highly specific for the diagnosis of SAPHO and may obviate biopsy. [ABSTRACT FROM AUTHOR]

Résumé Les articulations sterno-claviculaires (SCC) sont probablement trop rarement examinées par les rhumatologues, alors qu’elles peuvent être d’une grande aide dans le raisonnement diagnostique. Leur situation anatomique, à l’interface entre le thorax et l’épaule, peut égarer l’analyse sémiologique. Toute douleur de l’épaule ou de la paroi thoracique antérieure doit faire rechercher une pathologie de l’articulation SCC, par la recherche d’une tuméfaction ou rougeur locale, et la pression sur l’articulation. L’imagerie (radiographie, scanner, IRM, scintigraphie, échographie) est parfois rendue difficile d’interprétation du fait des structures adjacentes et de la fréquence des anomalies non spécifiques de cette articulation. La richesse en enthèses de cette région en fait le lit des atteintes des spondyloarthrites, bien connues et démontrées. L’atteinte dans le SAPHO, impressionnante par l’hyperostose et l’ostéite caractéristique, ne doit pas faire négliger les atteintes plus discrètes rencontrées dans les spondylarthrites ankylosantes ou les rhumatismes psoriasiques. Cependant, d’autres atteintes inflammatoires sont possibles : les atteintes infectieuses, à pyogènes ou à germes atypiques ou à croissance lente, mais aussi, de manière plus rare, les atteintes dans le cadre de la polyarthrite rhumatoïde ou des arthrites microcristallines. Enfin, les atteintes arthrosiques sont fréquentes après 50 ans, mais rarement symptomatiques. Sternoclavicular joints (SCC) are probably too rarely considered by the rheumatologists. However, they can be of great help in the diagnostic reflection. Their anatomical location, between the chest and the shoulder joint, can mislead the semiology analysis. Every patient presenting with shoulder pain must have an examination of the SCC, by looking for local swelling or redness, and pressuring the joint. Imaging (X-rays, CT-scan, MRI, scintigraphy, ultrasonography) can be hard to interpret because of the adjacent structures and the frequency of non-specific abnormalities of this joint. There are lots of entheses in this region, which explains the frequent and demonstrated correlation of SCC pathology with spondyloarthritis. In SAPHO syndrome, hyperostosis and osteitis are very impressive. However, one must not neglect the more discreet SCC symptoms encountered in ankylosing spondylitis and psoriatic arthritis. Other inflammatory conditions are possible in the SCC: septic arthritis (by pyogenic or atypical germs), and more rarely, rheumatoid arthritis or microcrystalline arthritis. Finally, osteoarthritis of the SCC is common over the age of 50, but rarely symptomatic. [ABSTRACT FROM AUTHOR]

Résumé Les luxations sternoclaviculaires sont rares, concernent généralement le sujet jeune et résultent le plus souvent de choc violent. À travers une revue de la littérature, les auteurs font le point sur l’épidémiologie, les mécanismes, les signes cliniques, l’imagerie et les traitements des luxations sternoclaviculaires d’origine traumatique. Les instabilités chroniques ne sont pas discutées. 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. [ABSTRACT FROM AUTHOR]

Copyright of Medicina Sportiva Bohemica et Slovaca is the property of Ceska spolecnost telovychovneho lekarstvi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: We describe the anatomical basis for microsurgical reconstruction of the sternoclavicular joint using a vascularized, innervated second metatarsophalangeal joint, the surgical technique, and outcomes in 2 patients. Methods: We harvested the second metatarsophalangeal joint along with the joint capsule, portions of the metatarsal and phalanx, the flexor sheath and flexor tendon, the extensor sheath and tendon, the first metatarsal artery, and the deep peroneal nerve. This composite tissue was used for reconstruction of an excised sternoclavicular joint following infection or chondrosarcoma. The proximal phalanx was dowel-jointed into the manubrium and fixed with 1 or 2 screws; the metatarsal was plated to the remaining clavicle. The joint was oriented to allow maximal elevation and restricted depression, and the normal mediolateral laxity allowed anterior and posterior movement. Vascular anastomoses were performed to branches of the thoracoacromial axis vessels, and digital nerves were connected to a supraclavicular nerve. Results: Two patients had their excised sternoclavicular joints reconstructed using this technique. Both achieved union at the clavicular and sternal junctions. Both obtained restoration of movement of the sternoclavicular joint and upper limb. One patient developed joint subluxation and pain requiring tendon graft reconstruction of the costoclavicular ligament. Conclusions: In these 2 cases, the vascularized second toe metatarsophalangeal joint satisfactorily reconstructed the widely excised sternoclavicular joint and costoclavicular ligament and restored function. Type of study/level of evidence: Therapeutic IV. [Copyright &y& Elsevier]

Background: The sternoclavicular joint (SCJ) is a true diarthrodial synovial joint and therefore vulnerable to the same disease processes as in other synovial joints. We identified a group of patients with monarticular arthritis of the SCJ that had a benign process and a self-limited disease course. Methods: This retrospective study included 25 female patients who presented with pain or swelling of the SCJ between January 2000 and December 2010. Their mean age was 59 years, and the average follow-up was 44 months. All patients underwent baseline radiographic imaging, technetium bone scan, computed tomography, and magnetic resonance imaging. Blood profiles were negative for rheumatoid factor in all patients. Functional outcome was assessed with the Rockwood SCJ score. Results: The patients presented with complaints of pain (72%), local swelling (88%), and redness (8%) that progressed during 4 weeks. The physical examination revealed tenderness (84%), swelling (88%), and limited range of motion (16%). These findings persisted for a median of 5 months. Plain radiographs showed arthritic changes in 5 patients (20%). Increased uptake was observed in all 9 patients who underwent a bone scan. Soft tissue swelling was demonstrated on computed tomography in 5 patients (20%) and on magnetic resonance imaging in 5 patients (20%). One patient had osteoarthritic changes on magnetic resonance imaging. Pain resolved spontaneously in all patients, leaving only swelling in 9 patients and tenderness in 1 patient. Conclusion: Our experience is that SCJ arthropathy may often be a self-limited disease. After being treated solely with nonsteroidal anti-inflammatory medication, 24 of the 25 study patients showed complete regression of pain and return to full function without recurrence of symptoms. Basic blood tests and radiographs are sufficient to rule out a septic joint. [Copyright &y& Elsevier]

Background: Chronic symptomatic anterior sternoclavicular (SC) instability is a rare condition with sparse treatment options. Owing to the rarity of the condition and the potential risk of fatal complications, only a few reports on treatment of this condition have been published. We evaluated a prospective series of patients with chronic anterior SC instability who underwent minimally open reconstruction with an autologous tendon graft. Methods: From 2002 to 2010, 32 consecutive patients underwent minimally open SC ligament reconstruction using a tendon autograft. A palmaris longus was used in 7 patients and a gracilis tendon autograft was used in 25. All patients with at least 2 years of follow-up were reviewed. Five were lost to follow-up. The remaining 27 patients (84.4%) were a median age of 35 years (range, 11-61 years) at surgery. Patients were evaluated with the Western Ontario Shoulder Instability (WOSI) score preoperatively and at follow-up at a median 54 months (range, 24-120 months) postoperatively. Results: The total WOSI score improved from a median of 44% (range 6%-62%) preoperatively to 75% (range, 13%-93%) at follow-up (P = .0001). Two failures (7.4%) occurred; after revision, both patients remained stable. After the operation, 17 of 25 patients (68%) complained of donor site morbidity, and 10 (40%) still had some discomfort at follow-up. No infections or local vascular complications occurred. Conclusions: Miniopen SC joint reconstruction using a tendon autograft results in prolonged improvement in shoulder function in most patients with symptomatic anterior SC instability. [Copyright &y& Elsevier]

Summary: Background: The pectoralis major (PM) flap is the workhorse flap for acute, sub-acute and chronic sternoclavicular infections (SCIs). Attempts at using only the clavicular head of the pectoralis major muscle (CPM), based on internal mammary perforators or the thoracoacromial artery, have been reported. We describe the harvest of a deltoid branch-based flap (CPM-DTA) and examine its use in managing a series of isolated, acute and sub-acute sternoclavicular infections. Methods: From 2007 to 2012, 28 subjects with SCI underwent PM flaps at our institution. Six were excluded for extensive chest wall involvement, and four were excluded from chronic osteomyelitis (5 months of infection or greater). Of the remaining 18 patients with isolated SCI, 12 underwent traditional PM flaps (Group-A), while six underwent CPM-DTA (Group-B). Features studied include age, gender, co-morbidities, culture, need for intra-operative extension of the sternoclavicular incision, postoperative complications, wound healing, time from infection onset to debridement, length of hospital stay, postoperative chest wall contour deformity and follow-up. Results: Infections resolved and wounds healed in all patients following a single reconstructive procedure. Intra-operative need for extended incisions and postoperative ipsilateral anterior chest wall contour deformity are noted in all Group-A subjects but in no Group-B subjects. Conclusion: In patients with isolated, acute and sub-acute SCI, the CPM-DTA flap achieves effective wound closure while avoiding large sternal incisions and the morbidity associated with standard PM muscle harvest. Harvesting the CPM-DTA flap preserves the sternocostal head of the pectoralis major muscle and its thoracoacromial pedicle. This preserves the muscle for future flap use if necessary. [Copyright &y& Elsevier]

Purpose: The purpose of this systematic review is to evaluate the current literature in an effort to investigate sleep quality and disturbances and the association with clinical outcomes of patients undergoing shoulder surgery.Methods: A systematic review of the PubMed, Embase, and Cochrane Library databases was performed according to PRISMA guidelines. All English-language literature reporting clinical outcomes and sleep quality and disturbance following shoulder surgery was reviewed by two independent reviewers. Outcomes assessed included patient-reported outcomes (PROs) and sleep quality. Specific PROs included the Pittsburgh Sleep Quality Index (PSQI), Visual Analog Scale (VAS) for pain, Simple Shoulder Test (SST), University of California Los Angeles (UCLA) Shoulder Rating Scale, and American Shoulder and Elbow Surgeons Score (ASES). Study methodology was assessed using the Modified Coleman Methodology Score. Descriptive statistics are presented.Results: Sixteen studies (11 level IV, 2 level III, 3 level II) with a total of 2748 shoulders were included (age, 12-91 years; follow-up, 0.25-132 months). A total of 2198 shoulders underwent arthroscopic rotator cuff repair (RCR), 131 shoulders underwent arthroscopic capsular release, 372 shoulders underwent total shoulder arthroplasty, 18 shoulders underwent comprehensive arthroscopic management, and 29 shoulders underwent sternoclavicular joint procedures. All shoulder surgeries improved self-reported sleep and PROs from pre-operatively to post-operatively. In RCR patients, PSQI scores were significantly associated with VAS scores, SST scores (r = 0.453, r = -0.490, p<0.05, respectively), but not significantly associated with UCLA Shoulder rating scale or the ASES scores (r = 0.04, r = 0.001, p>0.05, respectively). In TSA patients, PSQI scores were significantly associated with ASES scores (r = -0.08, p<0.05). All 4 RCR studies and 1 TSA study utilizing PSQI found significant improvements in mean PSQI scores within 6-24 months (p<0.05).Conclusions: Surgical intervention for rotator cuff tear and glenohumeral osteoarthritis significantly improves self-reported sleep in patients with shoulder pain. However, there remains a dearth of available studies assessing the effects of surgical intervention for adhesive capsulitis, sternoclavicular joint instability, and sternoclavicular osteoarthritis on sleep. Future studies should utilize sleep-specific PROs and quantitative measures of sleep to further elucidate the relationship between sleep and the effect of shoulder surgery. [ABSTRACT FROM AUTHOR]

Background: Sternoclavicular joint (SCJ) instability is relatively rare. Surgical treatment may be considered for severely displaced dislocations or symptomatic recurrent anterior instability. The purpose of this study was to describe an SCJ ligament reconstruction technique and retrospectively evaluate its safety and effectiveness for treating anterior SCJ dislocations and instability. Materials and methods: A retrospective review of demographics, medical history, injury characteristics, and pretreatment pain and functional levels was performed. A soft-tissue graft woven in a Roman numeral X pattern through clavicular and sternum subcortical bone tunnels was used. Patients were evaluated with postoperative visual analog scale (VAS) and functional scores, and their ability to return to normal preoperative sports and activities was determined. Results: Six patients were evaluated with a mean follow-up of 40 months (range, 24.5-58 months). Injury mechanisms included acute trauma (3 patients), minor trauma (1 patient), and chronic atraumatic instability (2 patients). The mean preoperative symptom duration was 11 months (range, 0.5-27.5 months). Autograft hamstring graft was used in all cases with no resulting surgical complications. All 6 patients had full range of motion with no instability after treatment. Five patients had no pain (0 of 10 on VAS), whereas one patient had mild pain (1 to 3 of 10 on VAS). All 6 patients had improved functional scores. All returned to preoperative activities and participation in sports. No recurrent instability occurred. In 1 case, failure occurred at 4 years with recurrent pain, and revision was performed. Conclusions: The results of our study indicate that reconstruction for anterior SCJ dislocation is safe with results comparable to previously described surgical stabilization techniques. This technique provides a surgical treatment option for symptomatic anterior SCJ dislocation and instability. [Copyright &y& Elsevier]

Background: Dislocations of the sternoclavicular joint are rare injuries caused by massive forces applied to the joint. A high rate of complications has been reported following this injury emphasizing the importance of an accurate diagnosis and therapy. Methods: We report a series of patients with chronic anterior or posterior sternoclavicular instability treated with figure-of-eight gracilis- or semitendinosus-tendon reconstruction. Tendon grafts were collected from the patient''s ipsilateral knee. Preoperative and postoperative DASH scores were compared to evaluate the outcome. Results: Six patients (mean age, 22 years; range 15-46; male = 3; female = 3) were included. The patients sustained an isolated dislocation of the sternoclavicular joint resulting from a high-energy trauma. Anterior instability was observed in 3 patients, posterior instability in 2 patients and the remaining patient showed multidirectional instability. The mean time from injury to operation was 8 months (range, 4-33). The semitendinosus tendon was used in 4 patients, the gracilis tendon in 2 patients, respectively. Follow-up examination was after 22 months (range, 14-34). The DASH score improved from 54.3 points (range, 45.7-68.8) preoperatively to 28.8 points (range, 25.8-34.5) postoperatively. All patients returned to full activity without limitations including competitive contact sports. Conclusion: Stabilization of the sternoclavicular joint with the figure-of-eight technique seems to be a feasible alternative for young and active patients with remaining instability following conservative treatment. [Copyright &y& Elsevier]

Background: Adolescent posteriorly displaced physeal injuries of the medial clavicle are uncommon. Up to 50% of conservatively treated patients remain symptomatic, and late surgery is hazardous. Stability is rarely achieved with closed or open reduction alone, and internal fixation is usually required. Previously described options for fixation achieve stability of the medial clavicle by securing it to the intact epiphysis. Because the epiphyseal fragment is small, fixation is achieved using sutures or wires. This relies on the size and structural integrity of the medial fragment, which in our experience can be variable. We hypothesized that a novel technique of operative stabilization of these injuries, which does not require fixation to the epiphyseal fragment and uses no metalwork, is safe and effective in treating these injuries. Materials and methods: The operative technique involves suturing the medial clavicle to the anterior platysmal and periosteal layer using absorbable sutures passed through drill holes in the medial clavicle. Patients were assessed clinically an average of 9 months after surgery. Results: We treated 7 patients with this method. There were no intraoperative complications. All patients were pain-free and symptom-free and had a full range of movement at follow-up. All patients had returned to their preinjury level of sports. Conclusions: We recommend this technique for treating these uncommon injuries. It is simple, safe, and reproducible and it produces good results. [ABSTRACT FROM AUTHOR]

Abstract: Sternoclavicular joint dislocation is an uncommon injury and few clinicians have a great deal of experience treating it. Clinically, it can be surprisingly easy to miss and the presentation is often delayed. Depending on the type of dislocation, the sequelae can be life-threatening or relatively benign. This article discusses the relevant anatomy, clinical presentation, investigation and management of sternoclavicular dislocation and injuries of the medial clavicular physis. [Copyright &y& Elsevier]

Background: Treatment for septic arthritis of the sternoclavicular (SC) joint with concomitant osteomyelitis of the clavicle often requires joint resection rather than simple incision and drainage. We evaluated the effectiveness of resection arthroplasty for patients with septic arthritis of the SC joint. Methods: We retrospectively reviewed 10 patients who underwent resection arthroplasty for SC joint septic arthritis between 1996 and 2008. The mean patient age was 52.8 ± 10.5 years (range, 40-72 years), the mean symptom duration before surgery was 16.9 days (range, 2-60 days), and the mean follow-up period was 35.4 ± 42.2 months (range, 10-108 months). Diagnoses were based on physical examination, laboratory tests, and radiologic studies including magnetic resonance imaging. Each patient had concomitant osteomyelitis of the clavicle. In addition, 4 patients had mediastinitis and 1 had osteomyelitis of the adjacent ribs. All patients underwent SC joint resection and intramedullary ligament reconstruction, followed by intravenous antibiotics for 4 to 8 weeks. Intraoperative cultures were positive in 6 patients. Results: All infections resolved, with only 1 patient having complications—systemic sepsis and pneumonia. The mean ranges of motion were 146° of forward flexion (range, 135°-155°) and 48° of external rotation (range, 40°-55°), with the internal rotation level ranging from T5 to L3. The mean superior migration of the clavicle was 1.5 mm (range, 0-4 mm), and the mean visual analog pain score was 1.4 ± 0.7 (range, 0-2). Conclusion: Resection arthroplasty in patients with septic SC joints results in relatively good shoulder function. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate the feasibility and therapeutic effect of treating sternoclavicular joint dislocation by K-wire and tension band wire fixation, and to improve the safety and stability of this technique. Methods: This study consisted of 9 cases, 6 males and 3 females with the mean age of 25 years (range, 9-62 years). The causes were traffic accident in 7 cases, falling in 1 case and fight in 1 case. The duration from injury to operation was 2 hours to 7 days. There were 5 left dislocations and 4 right dislocations; 8 anterior dislocations and 1 posterior dislocation, including one combined with left scapular fracture and one with left olecranon fracture. Open reduction and internal fixation using K-wires and tension band wires were performed to treat dislocations. Results: All patients were followed up for 6 to 24 months, 10 months on average. According to Rockwood''s rating scale on postoperative sternoclavicular joint, 8 cases achieved excellent outcomes with an average score of 13.88, and the rest case achieved a good outcome with the score of 12. Anatomical reduction was obtained in all cases. There were no such postoperative complications as severe infection, injury to blood vessel and nerve, failure of fixation, etc. Patients were all satisfied with the anatomical reduction and functional recovery. Conclusions: The technique of K-wire and tension band wire fixation is safe, simple, effective, less invasive and has been successfully used in orthopedic surgery. It is effective in treating sternoclavicular joint dislocation though it has some disadvantages. [Copyright &y& Elsevier]

Copyright of Journal of Ultrasound is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Septic arthritis in the sternoclavicular joint (SCJ) is uncommon. Early diagnosis is difficult because of its insidious onset and lack of a radiological reference standard. In addition to joint destruction and dysfunction, delayed diagnosis and treatment may result in additional expansion of infection, sepsis, and mortality. Case Report We present a previously healthy 38-year-old man who presented after 10 days of fever and painful swelling on the upper chest. Septic sternoclavicular arthritis and mediastinitis were diagnosed and treated by parenteral antibiotics and staged surgery. The range of motion in the right shoulder completely returned; however, mild weakness of the right shoulder remained. Conclusion In patients presenting with upper chest, neck, or shoulder pain, physicians should include SCJ arthritis as a differential diagnosis. Multiple imaging examinations are often needed to reach a diagnosis. In septic SCJ arthritis, early institution of appropriate antibiotics is important, and surgical interventions are often needed to eradicate the infection. [ABSTRACT FROM AUTHOR]

Clavicle fractures and acromioclavicular joint dislocations are very common injuries. However, the combination of both, known as "floating clavicle" is extremely rare, with approximately 40 cases reported. We report a case of a healthy 51-year-old male who suffered a high-velocity biking accident, with a bipolar clavicle injury (type IV acromioclavicular joint dislocation and proximal clavicle fracture), with concomitant rib fractures and pulmonary contusion. He received early surgical treatment by open reduction and osteosynthesis of the proximal clavicle (distal ulna plate, Protean ®) and open reduction and stabilization with a MINAR ® implant for the acromioclavicular joint. After an initial one-month immobilization, he started physical therapy. In the 10-month follow-up he presented with a pain-free full range of motion, a good cosmetic result, and radiological consolidation. Bipolar clavicle injury is a rare clinical entity that encompasses a spectrum of combined clavicle fractures, acromioclavicular or sternoclavicular joint dislocations. They are sustained in a high-energy context, and accompanying injuries must be sought. Diagnosis is made through X-Ray and CT. Despite the lack of clinical guidelines, most authors agree on surgical management of at least one of the injuries, with multiple surgical techniques available. There is an emphasis in surgical treatment of the young and active patient. Conservative treatment is associated with poorer results. It is advisable to have a high index of suspicion for floating clavicle in a high-energy trauma patient, given possible life-threatening injuries, and long-term shoulder sequelae. Surgery should be considered in a young and active patient. • "Floating clavicle" is a rare injury that should be suspected in a high energy accident. • Other life-threatening injuries must be ruled out. • There are no guidelines regarding best treatment. • Surgical treatment is usually advocated for young and active patients. • ORIF of sternoclavicular fracture and acromioclavicular joint dislocation yields good results. [ABSTRACT FROM AUTHOR]

Abstract: Tuberculosis may affect almost every part of the body. However, it is very uncommon for tuberculosis to involve the sternoclavicular joint. Demonstration of acid-fast bacilli, which is the gold standard for diagnosis, is extremely rare in these lesions. Diagnosis is usually based on demonstration of granulomas on histopathology. Good radiographs and imaging studies are supportive for diagnosis. We report a case of 32-year-old male who presented with a tender swelling over the medial end of the clavicle with a sinus and signs of inflammation. The fine needle aspiration of the lesion demonstrated acid-fast bacilli on Ziehl–Neelsen staining. The patient was put on antitubercular chemotherapy for 1 year and made an uneventful recovery. [Copyright &y& Elsevier]