Executive Editor: Joseph Schatzker General Editor: Jonas Andermahr, Michael McKee, Diane Nam

Clavicle 15.1 B Medial clavicle, intra articular - Reduction of sternoclavicular dislocation

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Glossary

Fractures of the medial clavicle are often a result of a high energy mechanism and associated with a multisystem polytrauma.

Although various techniques for surgical fixation have been reported (eg, suture/wire loop, hook plate, periarticular plate, conventional plate, spanning plate), there is currently no standardized operative procedure for these very rare injuries, which are predominantly treated nonoperatively.

A detailed description of any of these techniques is outside the scope of the surgery reference.


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Posterior sternoclavicular dislocation

An acute posterior sternoclavicular dislocation can be a life-threatening situation and an immediate closed reduction in the operating room should be undertaken as a potential life-saving procedure.


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This 3D CT shows posterior sternoclavicular dislocation.


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If a thoracic surgeon is available, he or she should be present from the very beginning of the procedure. Under general anaesthesia with the patient in a supine position, and a bolster between the shoulder blades, the arm is abducted and extended to allow the medial clavicle to reduce.


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If this is unsuccessful, a sharp towel clip may be placed percutaneously on the medial end of the clavicle and a very careful reduction maneuver with an anteriorly directed force is attempted.

Once reduced, the sternoclavicular joint is usually stable.


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Anterior, Superior, Inferior dislocations

Other dislocations of the medial sternoclavicular joint (eg, anterior, superior, inferior) are non-life-threatening. Although closed reduction maneuvers can be attempted, maintaining stable reduction is usually not possible. Thus, expectant management with reassurance is given with appropriate rehabilitation.

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