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.

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.

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

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 4right 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 24months, 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.

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.