Incidence of sports-related sternoclavicular joint dislocations in the United States over the last two decades

BACKGROUND Epidemiological understanding of acute sternoclavicular(SC)dislocations secondary to sports across the United States is poorly defined.AIM To identify and assess epidemiological trends of SC dislocations occurring secondary to sports-related mechanisms across United States over the past two decades.METHODS This cross-sectional,descriptive epidemiological study evaluates epidemiological trends of SC dislocations from sports that present to emergency departments(EDs)across the United States.Data were obtained from the National Electronic Injury Surveillance System database spanning two decades.Data on incidence,patient demographics,mechanisms of injury,dislocation types,incident locales,and patient dispositions were collected.RESULTS 1622 SC dislocations occurred nationwide from 2001 to 2020[incidence=0.262/1000000 people,confidence interval(CI)=0.250-0.275],comprising 0.1%of shoulder/upper trunk dislocations.Most patients were male(91%,n=1480)and aged 5-17(61%,n=982).Football,wrestling,and biking were the most frequently implicated sports,with contact sports responsible for 59%of athletic injuries(n=961).Recreational vehicle-related sports injuries,such as all-terrain vehicles,dirt bikes,and mopeds accounted for 7.8%of all injuries(n=126),with dirt bikes specifically comprising 3.7%(n=61).Ultimately,82%were discharged from the ED(n=1337),12%were admitted(n=194),and 6%were transferred(n=90).All recorded posterior dislocations were admitted or transferred from the ED.Patients sustaining SC dislocations from contact sports had a significantly increased risk of hospital admission or transfer rather than discharge from the ED as compared to patients whose injuries were from non-contact sports(incidence rate ratio=1.46,CI:=1.32-1.61,P<0.001).CONCLUSION SC dislocations from sports continue to be rare with a stably low incidence over the past two decades,likely comprising a smaller proportion of shoulder dislocations than previously thought.Contact sports are a frequent source of injury,especially among school-aged and teenage males.Most patients are discharged directly from the ED;however,a substantial number are hospitalized,many of which had documented posterior dislocations.Ultimately,understanding the epidemiology and mechanism-related trends of acute SC dislocations is important given the potential severity of these injuries,concentration in a specific population,and uncertainty linked to rare presentation.

Sternoclavicular joint dislocation and its management: A review of the literature

Dislocations of the sternoclavicular joint(SCJ) occur with relative infrequency and can be classified into anterior and posterior dislocation, with the former being more common. The SCJ is inherently unstable due to its lack of articular contact and therefore relies on stability from surrounding ligamentous structures, such as the costoclavicular, interclavicular and capsular ligaments. The posterior capsule has been shown in several studies to be the most important structure in determining stability irrespective of the direction of injury. Posterior dislocation of the SCJ can be associated with life threatening complications such as neurovascular, tracheal and oesophageal injuries. Due to the high mortality associated with such complications, these injuries need to be recognised acutely and managed promptly. Investigations such as x-ray imaging are poor at delineating anatomy at the level of the mediastinum and therefore CT imaging has become the investigation of choice. Due to its rarity, the current guidance on how to manage acute and chronic dislocations is debatable. This analysis of historical and recent literature aims to determine guidance on current thinking regarding SCJ instability, including the use of the Stanmore triangle. The described methods of reduction for both anterior and posterior dislocations and the various surgical reconstructive techniques are also discussed.

An Unusual Case of Sternoclavicular Joint Infection and Lung Abscess

Septic arthritis of the sternoclavicular joint is a rare and serious infection. A delay in the diagnosis may lead to serious complications. The appropriate medical and surgical treatment is crucial to the outcome. This article aims to report our experience in the successful management of sternoclavicular joint infection complicated with a lung infection. The authors present an unusual case of sternoclavicular joint infection extending into lung parenchyma with lung abscess formation in a diabetic patient, with uncontrolled diabetes that was successfully treated. At revaluation, he was asymptomatic with no evidence of relapse. Although sternoclavicular joint infection is a rare condition we highlight the importance of clinician’s awareness for an early diagnosis and treatment with broad-spectrum antibiotics and surgery.

Possibilities for arthroscopic treatment of the ageing sternoclavicular joint

AIM To investigate if there are typical degenerative changes in the ageing sternoclavicular joint(SCJ), potentially accessible for arthroscopic intervention.METHODS Both SCJs were obtained from 39 human cadavers(mean age: 79 years, range: 59-96, 13 F/26 M). Each frozen specimen was divided frontally with a band saw, so that both SCJs were opened in the same section through the center of the discs. After thawing of the specimens, the condition of the discs was evaluated by probing and visual inspection. The articular cartilages were graded according to Outerbridge, and disc attachments were probed. Cranio-caudal heights of the joint cartilages were measured. Superior motion of the clavicle with inferior movement of the lateral clavicle was measured.RESULTS Degenerative changes of the discs were common. Only 22 discs(28%) were fully attached and the discs were thickest superiorly. We found a typical pattern: Detachment of the disc inferiorly in connection with thinning, fraying and fragmentation of the inferior part of the disc, and detachment from the anterior and/or posterior capsule. Severe joint cartilage degeneration ≥ grade 3 was more common on the clavicular side(73%) than on the sternal side(54%) of the joint. In cadavers< 70 years 75% had ≤ grade 2 changes while this was the case for only 19% aged 90 years or more. There was no difference in cartilage changes when right and left sides were compared, and no difference between sexes. Only one cadaver-a woman aged 60 years-had normal cartilages. CONCLUSION Changes in the disc and cartilages can be treated by resection of disc, cartilage, intraarticular osteophytes or medial clavicle end. Reattachment of a degenerated disc is not possible.

Tuberculosis of the Sternoclavicular Joint: Report of 3 New Cases Observed in Abidjan

The sternoclavicular joint is a rare site of osteoarticular tuberculosis. We now report three new cases of sternoclavicular tuberculosis. The report concentrates mostly on immunocompromised patients, notably two with HIV infection and one case marked by its acute onset which is rather original because, in this case, there was a swollen sternoclavicular joint with normal X-ray and it was the CT-scan which showed the lesions. The etiological diagnosis was made in the first case by polymerase chain reaction and in the second case by identification of Mycobacterium tuberculosis. In the third case, the diagnosis was presumptive and the outcome on anti-tuberculous drugs was satisfactory. Sternoclavicular joint tuberculosis is unusual;the painful swelling of that joint should lead to realize a performed imaging such as CT-scan.

Tuberculosis Arthritis of the Sternoclavicular Joint

Tuberculosis remains a public health problem in developing country particularly in Tunisia. Bone location of tuberculosis infection is increasing and is often misdiagnosed due to the weakness of clinical presentation in early stages. Sternoclavicular joint tuberculosis is rare and unusual location of this disease. However, antibiotherapy and surgical debridement is still the basis of treatment. We report a case of sternoclavicular joint tuberculosis with a follow up of four years. The patient was treated surgically and put under antibiotherapy during twelve months. The site was sterilized. We report this case to show that debridement and antibiotherapy still efficient in tuberculous bone affection no matters the location.

Imageological measurement of the sternoclavicular joint and its clinical application

Background Dislocation of the sternoclavicular joint is rare.However,posterior dislocation compressing important structures in the mediastinum may be fatal.Early diagnosis and prompt therapy of sternoclavicular joint dislocation are important.Computed tomography （CT） is an optimal means to investigate sternoclavicular joint anatomy; however,there are few reports on the imageological anatomical features of the sternoclavicular joint.The study investigated imageological anatomical features,and a new plate was devised according to these data to treat sternoclavicular joint dislocation.Methods Fifty-three healthy Chinese volunteers examined with chest CT were included in the study.The coronal,sagittal,and axial images of the sternoclavicular region were reconstructed.The sternal head diameter in the inferolateral-to-superomedial direction,length of the clavicular notch,and angle between the clavicular notch and sternum were measured on coronal images.The angle between the presternum and trunk was measured on sagittal images.The following dimensions were measured on axial images：anteroposterior dimensions of the sternal head,clavicular notch,and presternum; width of the sternoclavicular joint; distance between bilateral clavicles; and minimal distance from the presternum to the underlying structures in the thoracic cavity.A new plate was designed according to the above data and was used to repair six sternoclavicular joint dislocations.All cases were followed up with a range of 9 to 12 months.Results The proximal clavicle is higher than the presternum in a horizontal position.On axial images,the anteroposterior dimension of the sternal head was longer than the presternum,and the center region of the presternum was thinner than the edges.The left sternoclavicular joint space was （0.82±0.21） cm,and the right was （0.87±0.22） cm.Among the structures behind the sternum,the left bilateral innominate vein ran nearest to the presternum.The distance from the anterior cortex of the sterna to the left bilateral innominate vein was （2.38±0.61） cm.The dislocated joints were reduced anatomically and fixed with the new plate.All cases obtained satisfactory outcomes in follow-up visits.Conclusions Normal sternoclavicular joint parameters were measured on CT images,which can facilitate treatment of sternoclavicular joint dislocation or subluxation.This newly designed plate can be used to treat sternoclavicular joint dislocation effectively and safely.

Extended sternoclavicular joint infections in cirrhotic patients: staged interdisciplinary approach with thoracic and plastic surgery

Aim: Sternoclavicular joint infection associated with liver cirrhosis is an uncommon condition and the optimal surgical treatment is undefined. Methods: Patients and methods: we retrospectively analysed data from six patients with sternoclavicular joint infections and liver cirrhosis underwent between February 2008 and May 2018 a staged therapy using negative pressure therapy followed by secondary 'en bloc' joint resection and a pectoralis muscle flap (PMF) obliteration of the thoracic wall defect. Results: Four patients successfully underwent a transfer of the PMF. The surgical revision was required for relevant bleeding in one and a tracheostomy was performed due to the prolonged intubation in another case. One patient died on the fifth day after surgery due to a cerebral septic embolic ischemia and aortic endocarditis. Conclusion: The presence of liver insufficiency and coagulopathy was associated with an extensive blood product demand and required a well-balanced interdisciplinary management. During the follow-up only a minimal restriction in the shoulder mobility was observed.

K-wire and tension band wire fixation in treating sternoclavicular joint dislocation

目的将评估可行性和由 K 电线和紧张乐队电线固定对待 sternoclavicular 关节脱臼的治疗学的效果，并且改进这种技术的安全和稳定性。这研究与平均数由 9 个盒子， 6 男性和 3 女性组成了的方法 25 年变老(范围， 9-62 年) 。原因是在 7 种情况中的交通事故，掉在在 1 种情况中的 1 种情况和战斗里。到操作的从损害的持续时间是到 7 天的 2 个小时。有 5 左脱臼和 4 正确脱臼；8 前面的脱臼和 1 以后的脱臼，包括一个与左 olecranon 骨折与左肩胛骨折和破裂结合了。用 K 电线和紧张乐队电线的开的减小和内部固定被执行对待脱臼。结果所有病人被跟随在上面为 6 ～ 24 个月， 10 个月平均。根据 Rockwood 手术后的 sternoclavicular 关节上的等级规模， 8 个盒子与 13.88 的一个平均分数完成了优秀结果，并且剩余的盒子与 12 的分数完成了好结果。解剖减小在所有情况中被获得。象严重感染没有如此的手术后的复杂并发症，对血容器和神经的损害，固定的失败，等等。病人们都对解剖减小和功能的恢复满意。K 电线和紧张乐队电线固定的技术是保险箱的结论，简单，有效，不太侵略并且成功地在矫形外科被使用了。它在尽管它有一些劣势，对待 sternoclavicular 关节脱臼是有效的。

锁骨近端骨折的手术治疗方法及分型探讨

目的:总结不同锁骨近端骨折的手术治疗方法并探讨锁骨近端骨折的分型。方法:2017年1月至2020年12月收治24例移位型锁骨近端骨折患者,男16例,女8例;年龄28~66岁;其中新鲜骨折20例,陈旧性骨折4例。骨折Edinburgh分型,1B1型14例,1B2型10例。根据不同骨折分型选择不同的内固定方式进行内固定治疗。记录手术时间、失血量、术前后移位差异、骨折愈合时间及Rockwood评分结果。结果:24例患者获得随访,时间12~24个月。术后无感染、复位丢失情况发生,有3例患者出现内固定失效断裂退钉情况,取出内固定装置。手术时间30~65 min,失血量15~40 ml。无重要神经血管脏器损伤。影像学愈合时间3~6个月。末次随访Rockwood功能评分(13.50±1.86)分,疼痛(2.57±0.50)分、活动范围(2.78±0.41)分、肌肉强度(2.93±0.28)分、日常活动受限(2.85±0.35)分、主观结果(2.63±0.61)分,其中优20例,良3例,可1例。结论:锁骨近端骨折是一种发生率较低的骨折类型,针对不同的骨折分型可对应选择不同内固定方法及治疗方式,均取得较为满意的手术效果。

锁胸筋膜联合颈浅丛阻滞在锁骨骨折手术的应用研究

目的本研究旨在观察锁胸筋膜联合颈浅丛阻滞对锁骨骨折手术患者术中及术后肌力和疼痛评分的影响。方法在锁骨骨折手术中,纳入基线匹配的50例单侧锁骨中段骨折患者,通过完全随机数字表法原则,将患者分成锁胸筋膜联合颈浅丛阻滞组26例与肌间沟臂丛联合颈浅丛神经阻滞组25例。基本操作主要是采用B超引导穿刺,使用0.375%罗哌卡因共38mL进行麻醉,肌间沟臂丛联合颈浅丛神经阻滞组经肌间沟臂丛神经阻滞30mL,锁胸筋膜联合颈浅丛阻滞组经锁胸筋膜阻滞内外侧各15mL,记录两组患者麻醉前(T1),麻醉后20min(T2),手术结束后(T3)的平均动脉血压(MAP)、心率(HR)、血氧饱和度(SPO2),采用针刺法评估T2感觉阻滞效果,应用肌力评分和视觉疼痛评分(VAS)对T3的肌力及术毕对整个手术过程疼痛进行分级。结果两组MAP、HR、SPO2、麻醉后20min的感觉阻滞效果、整体麻醉效果评价差异无统计学意义(P>0.05),锁胸筋膜联合颈浅丛阻滞能满足锁骨骨折手术的麻醉要求,且在术毕肌力明显优于肌间沟神经阻滞,差异有统计学意义(P<0.05)。结论肌间沟臂丛神经阻滞与锁胸筋膜平面阻滞应用于锁骨骨折手术的安全性和麻醉效果相似,锁胸筋膜联合颈浅丛阻滞能满足锁骨骨折手术麻醉需求的同时,保留上肢的运动能力。

胸锁钩钛板治疗胸锁关节脱位和锁骨近端骨折

2015年5月~2020年10月,我科采用胸锁钩钛板治疗32例胸锁关节脱位和锁骨近端骨折患者,疗效满意,报道如下。1 材料与方法1.1 病例资料本组32例,男19例,女13例,年龄20~66岁。胸锁关节脱位12例,锁骨近端骨折20例。均为闭合损伤。伤后至手术时间3~7 d。1.2 治疗方法全身麻醉或臂丛+颈丛神经阻滞麻醉下手术。患者仰卧位,上胸背部垫薄枕。

VMAT混合布野在左侧乳腺癌胸锁联合放疗中的可行性研究

目的:研究以容积旋转调强放疗(volume modulated arc therapy,VMAT)技术为基础的混合布野的方法 HVMAT(hybrid-VMAT)在左侧乳腺癌胸锁联合放疗中的可行性。方法:选取左侧乳腺癌胸锁联合放疗患者21例,分别使用dMLC(dynamic multi-leave collimator)、VMAT和HVMAT方法进行计划设计,并分别命名为dMLC计划、VMAT计划与HVMAT计划。比较3种计划在计划靶区(planning target volume,PTV)、危及器官剂量分布上的差异。使用SPSS27.0软件进行统计学分析。结果 :3种计划间PTV剂量分布差异均具有统计学意义(P<0.05)。与dMLC计划相比,HVMAT计划的D_(98)、CI较大,Dmean较小,差异具有统计学意义(P<0.05);与VMAT计划相比,HVMAT计划的D_2、HI、D_(mean)更小,差异具有统计学意义(P<0.05)。与dMLC计划相比,HVMAT计划的左肺V_(30)更低,与VMAT计划相比,HVMAT计划的V_(10)和V_5更低,差异均具有统计学意义(P<0.05)。HVMAT计划的右肺V_5和D_(mean)介于dMLC计划和VMAT计划之间,HVMAT计划的心脏V30和Dmean最低。3种计划间脊髓D_(max)的差异无统计学意义。结论:HVMAT应用于左侧乳腺癌胸锁联合放疗不仅可提供更优的靶区剂量分布,还可进一步降低危及器官剂量。

钢缆内固定锁骨近段和胸骨髓腔修复胸锁关节脱位：解剖与临床

背景:对于需要内固定治疗的胸锁关节脱位,因其毗邻纵膈等重要结构,风险相对较大,而内固定方法多样,仍存争议。目的:探讨通过锁骨近段髓腔和胸骨髓腔内固定治疗胸锁关节脱位的可行性与有效性。方法:在防腐固定的22侧成人上肢标本上,观测胸锁关节形态、相关韧带等解剖学特点,测量锁骨内侧端、胸骨柄之关节面大小,关节盘形态,肋锁韧带、胸锁韧带形态。2009年1月至2012年7月用钢缆或可吸收缝线"8"形内固定治疗胸锁关节脱位患者3例,均为男性,年龄9,45,62岁,平均年龄38.6岁,采用上肢功能DASH评分对内固定效果进行评估。结果与结论:解剖学结果显示,锁骨内侧端关节面的前后径、冠状径都要大于胸骨柄上关节面的前后径、冠状径,2者之间并不匹配;胸骨柄在关节面上缘处的厚度最小,胸骨角处的厚度最大;胸骨柄的宽度在关节面上缘水平最小,关节面下缘最宽。关节盘的外观近,似椭圆形,冠状径大于前后径,与胸骨柄侧关节面较匹配,中央厚度大于边缘厚度。肋锁韧带厚度要明显大于胸锁前韧带和胸锁后韧带,外观更为致密;胸锁前韧带和胸锁后韧带的长、宽、厚较接近。临床试验结果显示,3例患者随访时间14-36个月,DASH评分10-16分,平均13.3分,内固定效果满意。提示通过钢缆或可吸收缝线近段锁骨髓腔和胸骨髓腔内固定修复胸锁关节脱位安全有效。

新型胸锁钩钢板治疗胸锁关节周围不稳定性骨折脱位的疗效观察

目的：探讨新型胸锁钩钢板治疗胸锁关节周围不稳定性骨折脱位的临床疗效。方法 ：自2011年6月至2013年12月,应用胸锁钩钢板对32例成年胸锁关节骨折脱位患者进行手术治疗。其中男24例,女8例;年龄25-76岁,平均42岁;胸锁关节前脱位12例,胸锁关节后脱位5例,锁骨内侧端骨折10例,骨折合并脱位5例。胸锁关节前骨折脱位采用标准胸锁钩钢板,后脱位则在钢板钩的远端,即胸骨柄前方加用螺母和垫片,预防术后再脱位。根据Rockwood评分法评定疗效。结果 ：患者手术过程中无并发症发生。术后复查X线片及CT显示胸锁关节解剖位置正常,内固定位置良好。32例均获得随访,时间6-24个月,平均10个月。术后3-6个月骨折达Ⅰ期愈合,胸锁关节无再脱位,锁骨内侧端解剖结构均恢复,功能满意,其中9例患者胸锁关节周围存在肿胀,但无疼痛等症状。Rockwood评分结果12.78±1.43;疗效优24例,良8例。结论：使用该新型胸锁钩钢板治疗胸锁关节周围不稳定性骨折,内植物固定确实可靠,安全性高,操作简便,为治疗此类创伤提供了一种可靠的方法。

胸锁钩钢板治疗胸锁关节脱位的临床观察

目的:观察应用胸锁钩钢板治疗胸锁关节脱位患者的临床治疗效果。方法:2010年6月至2012年6月对7例胸锁关节脱位患者行胸锁钩钢板复位固定术治疗,其中男5例,女2例;年龄38～54岁,平均42.3岁;病程1～4周。术前患者均有外伤史,患侧胸锁关节肿胀、疼痛明显,患侧肩关节活动明显受限。术前X线片及CT证实为胸锁关节脱位,根据Rockwood评分法对术后疗效进行评价。结果:本组7例胸锁关节脱位患者按Rockwood评分法进行评价,优6例,良1例。术后未出现内固定松动、断裂,未出现再次脱位,肩关节功能良好,胸锁关节无疼痛,外观无畸形,患肢活动自如无疼痛。结论:胸锁钩钢板治疗胸锁关节脱位,手术操作简单,固定可靠,疗效肯定,值得临床推广。

锁骨钩钢板在胸锁关节脱位治疗中的应用

目的 ：探讨应用锁骨钩钢板治疗胸锁关节脱位的方法及疗效。方法 ：2010年1月至2014年3月,采用锁骨钩钢板固定治疗胸锁关节脱位患者6例,其中男5例,女1例;年龄26~48岁,平均34岁;病程3~20 d。患者均为外伤后患侧胸锁关节肿胀、疼痛,患侧肩关节活动明显受限,经X线片及CT诊断为胸锁关节前脱位,根据Rockwood评分法对术后疗效进行评价。结果：所有患者术后切口愈合良好,外观美观;X线片显示胸锁关节脱位复位良好,钢板位置良好。6例患者均获随访,时间4~18个月,平均12个月。根据Rockwood评分法进行疗效评定：优4例,良1例,可1例,未见内固定失效及再脱位,无血管、神经及胸膜等副损伤。结论 ：锁骨钩钢板能在复位固定胸锁关节的同时保留胸锁关节微动功能,且不损伤胸锁关节软骨面。手术安全性高,固定效果好,患者术后可进行早期康复锻炼。

切除性胸锁关节成形术治疗胸锁关节脱位

目的 :探讨切除性胸锁关节成形术治疗胸锁关节脱位的临床应用可行性。方法 :采用切除性胸锁关节成形术和修复或重建肋锁韧带治疗 5例胸锁关节脱位的病例 ,并对结果进行平均 1.8年随访、评价。结果 :全部病例均随访平均 1.8年 ,所有病人均获优秀效果 ,无感染、疼痛、畸形。结论 :我们认为切除性胸锁关节成形术 ,保留或重建肋锁韧带是治疗胸锁关节脱位疗效可靠的方法。

T形钢板内固定治疗胸锁关节脱位与锁骨近段骨折

目的探讨T形钢板治疗胸锁关节脱位、锁骨近段骨折的临床疗效,以提高胸锁关节脱位与锁骨近段骨折治疗的安全性和稳定性。方法 6例患者均采用切开复位于骨折处安放4~6孔斜T形钢板,胸锁关节脱位患者去除胸锁关节软骨,T形钢板均置于胸骨端。术后逐步指导患者行功能锻炼,6周后恢复正常活动。结果术后X线片示脱位复位及内固定位置良好,均恢复解剖结构。外观及功能满意。6例均获随访,时间3~70个月。疗效根据Rockwood评分法进行评定：优4例,良2例。未出现神经血管损伤、血气胸、内固定失效、再脱位等并发症。结论胸锁关节脱位采用T形钢板钢板固定具有稳定性好、风险小、损伤心脏及血管可能性低的优点,患者能早期进行功能锻炼,可最大程度地恢复肩关节功能,是治疗胸锁关节脱位与锁骨近段骨折有效方法。