Sternoclavicular dislocation - Revision history

Rossdonaldson1: /* Management */

2020-06-13T20:35:12Z

Management

← Older revision		Revision as of 20:35, 13 June 2020
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	*May be associated with life-threatening injuries:		*May be associated with life-threatening injuries:
	**[[Pneumothorax]], compression/laceration of surrounding great vessels, trachea, or esophagus		**[[Pneumothorax]], compression/laceration of surrounding great vessels, trachea, or esophagus
	*Consult ortho for closed reduction (ideally performed in the OR or under [[~~Procedural Sedation~~]])		*Consult ortho for closed reduction (ideally performed in the OR or under [[procedural sedation]])
	**Reduction must be performed with Cardiothoracic Surgery on-call or nearby due to potential for great vessel injury during reduction / manipulation		**Reduction must be performed with Cardiothoracic Surgery on-call or nearby due to potential for great vessel injury during reduction / manipulation
	*Create a sterile field with appropriate skin prep.		**Create a sterile field with appropriate skin prep.
	*A metal towel clip is inserted percutaneously and is used to grasp the medial clavicle, pulling anteriorly until reduction is complete		**A metal towel clip is inserted percutaneously and is used to grasp the medial clavicle, pulling anteriorly until reduction is complete
	*May be observed afterwards due to severity of trauma and risk for vascular injury<ref>Deren ME et al. Posterior sternoclavicular dislocations: a brief review and technique for closed management of a rare but serious injury. Orthopedic Reviews 2014; 6: 5245. PMID: 24744842</ref>		**May be observed afterwards due to severity of trauma and risk for vascular injury<ref>Deren ME et al. Posterior sternoclavicular dislocations: a brief review and technique for closed management of a rare but serious injury. Orthopedic Reviews 2014; 6: 5245. PMID: 24744842</ref>

	==Disposition==		==Disposition==

Rossdonaldson1: /* Background */

2020-06-13T20:28:08Z

Background

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	*Anterior dislocations are much more common than posterior		*Anterior dislocations are much more common than posterior
	*Due to both force and anatomic location, damage to the brachial plexus, subclavian, trachea, and esophagus may occur<ref name="Balcik">Balcik BJ et al. Evaluation and treatment of sternoclavicular, clavicular, and acromioclavicular injuries. Prim Care Clin Office Pract 40 (2013): 911-923. PMID: 24209725</ref>		*Due to both force and anatomic location, damage to the brachial plexus, subclavian, trachea, and esophagus may occur<ref name="Balcik">Balcik BJ et al. Evaluation and treatment of sternoclavicular, clavicular, and acromioclavicular injuries. Prim Care Clin Office Pract 40 (2013): 911-923. PMID: 24209725</ref>
			*Atraumatic subluxation possible in younger patients

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Background */

2020-06-13T20:27:31Z

Background

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	[[File:PMC3898097 1754-9493-7-38-1.png\|thumb\|Sternoclavicular anatomy with ligaments.]]		[[File:PMC3898097 1754-9493-7-38-1.png\|thumb\|Sternoclavicular anatomy with ligaments.]]
	[[File:PMC4481669 10.1177 1941738113502153-fig11.png\|thumb\|Mediastinal contents directly posterior to the sternoclavicular joint.]]		[[File:PMC4481669 10.1177 1941738113502153-fig11.png\|thumb\|Mediastinal contents directly posterior to the sternoclavicular joint.]]
	*Very stable joint making a dislocation rare; majority of injuries are simple sprains		*Sternoclavicualr joint is only true articulation between the upper extremity and the axial skeleton
			**Very stable joint making a dislocation rare; majority of injuries are simple sprains
	*Dislocations usually require severe force (MVC, sports injuries)		*Dislocations usually require severe force (MVC, sports injuries)
	**Mechanism either direct blow to the chest, or lateral compression		**Mechanism either direct blow to the chest, or lateral compression
	*Anterior dislocations are much more common than posterior		*Anterior dislocations are much more common than posterior
	*Due to both force and anatomic location, damage to the brachial plexus, subclavian, trachea, and esophagus may occur<ref name="Balcik">Balcik BJ et al. Evaluation and treatment of sternoclavicular, clavicular, and acromioclavicular injuries. Prim Care Clin Office Pract 40 (2013): 911-923. PMID: 24209725</ref>		*Due to both force and anatomic location, damage to the brachial plexus, subclavian, trachea, and esophagus may occur<ref name="Balcik">Balcik BJ et al. Evaluation and treatment of sternoclavicular, clavicular, and acromioclavicular injuries. Prim Care Clin Office Pract 40 (2013): 911-923. PMID: 24209725</ref>
	*Trivia - SC joint is only true articulation between the upper extremity and the axial skeleton

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Evaluation */

2020-06-13T20:26:36Z

Evaluation

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	*Serendipity view Xray		*Serendipity view Xray
	**Xray taken at a 40 degree cephalic tilt may be useful if CT unavailable.<ref name="Balcik"></ref>		**Xray taken at a 40 degree cephalic tilt may be useful if CT unavailable.<ref name="Balcik"></ref>
	*MRI is a consideration, though less likely to be practical

	==Management==		==Management==

Rossdonaldson1: /* Background */

2020-06-13T20:24:53Z

Background

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	==Background==		==Background==
	[[File:~~Sternoclavicular dislocation~~.png\|thumb\|Sternoclavicular ~~dislocation~~]]		[[File:PMC3898097 1754-9493-7-38-1.png\|thumb\|Sternoclavicular anatomy with ligaments.]]
	[[File:PMC4481669 10.1177 1941738113502153-fig11.png\|thumb\|Mediastinal contents directly posterior to the sternoclavicular joint.]]		[[File:PMC4481669 10.1177 1941738113502153-fig11.png\|thumb\|Mediastinal contents directly posterior to the sternoclavicular joint.]]
	*Very stable joint making a dislocation rare; majority of injuries are simple sprains		*Very stable joint making a dislocation rare; majority of injuries are simple sprains

Rossdonaldson1: /* Clinical Features */

2020-06-13T20:20:57Z

Clinical Features

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	==Clinical Features==		==Clinical Features==
	[[File:PMC3867956 CRIM.ORTHOPEDICS2013-386089.002.png\|thumb\|Photo showing right-sided sternoclavicular ~~abnormality~~.]]		[[File:PMC3867956 CRIM.ORTHOPEDICS2013-386089.002.png\|thumb\|Photo showing right-sided sternoclavicular displacemnt.]]
	*Severe pain that is exacerbated by arm motion and lying supine		*Severe pain that is exacerbated by arm motion and lying supine
	*Shoulder appears shortened and rolled forward		*Shoulder appears shortened and rolled forward

Rossdonaldson1: /* Clinical Features */

2020-06-13T20:20:02Z

Clinical Features

← Older revision		Revision as of 20:20, 13 June 2020
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	==Clinical Features==		==Clinical Features==
			[[File:PMC3867956 CRIM.ORTHOPEDICS2013-386089.002.png\|thumb\|Photo showing right-sided sternoclavicular abnormality.]]
	*Severe pain that is exacerbated by arm motion and lying supine		*Severe pain that is exacerbated by arm motion and lying supine
	*Shoulder appears shortened and rolled forward		*Shoulder appears shortened and rolled forward

Rossdonaldson1: /* Evaluation */

2020-06-13T20:11:17Z

Evaluation

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	==Evaluation==		==Evaluation==
			[[File:PMC3867956 CRIM.ORTHOPEDICS2013-386089.001.png\|thumb\|Xray with sternoclavicular dislocation (floating clavicle), as well as fracture lateral clavicle fracture (right).]]
	*CT		*CT
	**Study of choice (plain films may not be diagnostic)		**Study of choice (plain films may not be diagnostic)
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	**Xray taken at a 40 degree cephalic tilt may be useful if CT unavailable.<ref name="Balcik"></ref>		**Xray taken at a 40 degree cephalic tilt may be useful if CT unavailable.<ref name="Balcik"></ref>
	*MRI is a consideration, though less likely to be practical		*MRI is a consideration, though less likely to be practical

	==Management==		==Management==
	*Symptoms of stridor, shortness of breath, or dysphagia, indicate aerodigestive tract injury and require immediate reduction. Also immediately reduce if evidence of vascular occlusion.		*Symptoms of stridor, shortness of breath, or dysphagia, indicate aerodigestive tract injury and require immediate reduction. Also immediately reduce if evidence of vascular occlusion.

Rossdonaldson1: /* Disposition */

2020-06-13T20:07:36Z

Disposition

← Older revision		Revision as of 20:07, 13 June 2020
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	==Disposition==		==Disposition==
	===Anterior===		===Anterior Dislocation===
	*Ortho follow up within several days		*Ortho follow up within several days

	===Posterior===		===Posterior Dislocation===
	*Immediate ortho consult, with potential transfer to facility with BOTH Ortho and CT surgery		*Immediate ortho consult, with potential transfer to facility with BOTH Ortho and CT surgery

Rossdonaldson1: /* Anterior */

2020-06-13T20:06:35Z

← Older revision		Revision as of 20:06, 13 June 2020
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	==Disposition==		==Disposition==
	===Anterior===		===Anterior===
	**Ortho follow up within several days		*Ortho follow up within several days

	===Posterior===		===Posterior===