Sternoclavicular Joint Posterior Fracture-Dislocations

Posterior sternoclavicular dislocations are difficult to diagnose acutely and often require a CT scan.

Preoperative CT/MRI will identify physeal fracture versus sternoclavicular joint (SCJ) dislocation (Figure 1-1)
Because the clavicle does not finish ossification until 21 to 25 years of age, physeal fractures of the medial clavicle are more common than true SCJ dislocations, even in otherwise skeletally mature young adults.

We advocate careful open reduction internal fixation of posterior sternoclavicular fracturedislocations, which is a preferred and recommended definitive treatment.

Positioning

Modified beach chair positioning on a regular OR table with head elevated about 30° (Figure 1-2)
Padded bump between scapulae
Head and neck positioned with an endotracheal tube to the opposite side
Prep entire upper limb, shoulder girdle, hemi-thorax crossing the midline beyond the opposite sternoclavicular joint (SCJ), sternum, and upper abdomen below xyphoid (Figure 1-3)
- For full exposure of affected SCJ
- In case of emergency, sternotomy for bleeding control
- To allow manipulation of ipsilateral arm for reduction maneuver
Large bore IV access

Surgical Approach

Langer’s line incision from medial to SCJ to mid-diaphysis clavicle (Figure 1-4)

Dissect down to periosteum, identifying and protecting supraclavicular cutaneous nerves

Figure 1-1 ▪ CT scan images of posterior SC joint dislocation and its 3D reconstruction. (Reprinted with permission from Waters PM, Skaggs DL, Flynn JM. Rockwood and Wilkins Fractures in Children. 9th ed. Philadelphia, PA: Wolters Kluwer; 2019.)

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