Sternoclavicular dislocation: Difference between revisions
(Created page with "==Background== SC joint is freely movable synovial joint Allows movement in nearly all planes Very strong/stable due to connective tissue stabilizers - dislocation is UNCOMMO...") |
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==Treatment== | ==Treatment== | ||
===Anterior=== | |||
Anterior | |||
-Reduction if you desire | -Reduction if you desire | ||
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-Ortho f/u | -Ortho f/u | ||
===Posterior=== | |||
Posterior | |||
-Difficult to reduce | -Difficult to reduce | ||
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-Admit if other mediastinal injury | -Admit if other mediastinal injury | ||
==Source== | ==Source== | ||
Revision as of 04:08, 27 October 2011
Background
SC joint is freely movable synovial joint
Allows movement in nearly all planes
Very strong/stable due to connective tissue stabilizers - dislocation is UNCOMMON
Requires substantial force to dislocate
Anterior dislocation:posterior ratio 9:1
Mechanism
Anterior: anterior blow to lateral shoulder levers medial clavicle out
Poster: usually direct blow to medial clavicle
Presentation
Anterior
-usually not subtle
-can happen in elderly without significant trauma
-minimal potential for resultant morbidity
Posterior
Associated with sig force
25% incidence of mediastinal injury
-tracheal rupture
-PTX
-SVC lac
-Subclavian occlusion
-Vocal cord palsy
Imaging
Rountine Xray may appear nl
Serendipity View: 40˚ from vertical, direct cephalad
CT modality of choice
-can demonstrate co-injuries
MRI/MRA if necessary
Treatment
Anterior
-Reduction if you desire
-Bolster between shoulder blades, abduct arm to 90˚, press medial clavicle posteriorly and inferiorly
-May not reduce 2/2 interposed ligaments
-May not stay reduced 2/2 loss of ligament support
-Sling
-Ortho f/u
Posterior
-Difficult to reduce
-Prep, place towel clips, pull anteriorly while (assistant) placing traction and abduction to ipsilateral arm
-Sling
-Ortho f/u
-Admit if other mediastinal injury
Source
Perron (ACEP '09)