Clavicle fractures are frequently encountered in the field of orthopaedics. Generally viewed as straight-forward injuries, these fractures typically have a positive outcome with appropriate management. However, the presence of an ipsilateral sternoclavicular joint dislocation complicates the scenario significantly, making it an orthopaedic rarity worth studying. In a report featured in the Journal of Clinical Orthopaedics and Trauma (DOI: 10.1016/j.jcot.2018.08.002), medical practitioners faced precisely this challenge (Yadav et al., 2020).

A 50-year-old female sustained injuries in a road accident that yielded two significant upper-body traumas: an anterior dislocation of the sternoclavicular joint and a concurrent fracture of the right midshaft clavicle with inferior angulation of the fracture fragments. The medical team confronting this case faced a decision that could influence the patient’s recovery trajectory and long-term shoulder girdle function.

Specialists Yadav Siddhart, Khanna Vikram, and Mukherjee Sunirmal applied their expertise to the woman’s injuries, combining operative and non-operative tactics. The dislocation was addressed surgically with sternoclavicular joint stabilization using sutures, while the clavicle fracture was managed non-operatively. Six months after the management, it was reported that the sternoclavicular joint remained stable and the clavicle shaft united completely (Yadav et al., 2020).

This unusual case falls within the scope of orthopaedic anomalies due to the rare occurrence of sternoclavicular joint dislocations in conjunction with clavicle fractures. Clavicle fractures alone are common and account for approximately 2.6-4% of all adult fractures (Nowak, Holgersson, & Larsson, 2005), but the combination with a sternoclavicular joint dislocation is far less frequent.

Historically, isolated anterior dislocations of the sternoclavicular joint have been treated both conservatively and surgically, depending on the severity and the presence of associated complications such as in the case described by Khalid et al. (2013). Recognizing this, the report by Yadav and colleagues provides valuable insight into the management of such a joint dislocation when paired with a clavicle fracture.

Contemporary treatment protocols for sternoclavicular dislocations range from non-operative measures, such as immobilization with a figure-of-eight bandage, to varied surgical procedures like open reduction and fixation or even sternoclavicular joint reconstruction with grafting (Thomas, Williams, & Hoddinott, 2000). Non-operative management of clavicle shaft fractures is commonplace unless certain complications or patient conditions prompt surgical intervention (Paladini et al., 2012).

Given the success reported by Yadav and colleagues in managing this complex injury, it serves as a critical point of reference and lends confidence to orthopaedic surgeons who may encounter similar cases. It also exemplifies the evolving nature of orthopaedic trauma care, which is increasingly able to address multiple injuries in a single therapeutic approach.

Acknowledging previous literature, including works by Tompkins et al. (2010) regarding posterior sternoclavicular disruptions and ipsilateral clavicle fractures in young athletes, and O’Connor et al. (2003) discussing retrosternal dislocations, helps put this current case study into a broader context. The importance of individual case assessment cannot be overstated, as it determines the therapeutic route and ultimately the patient’s return to function.

Furthermore, studies like that of Burrows (1951) emphasized techniques such as tenodesis for recurrent sternoclavicular joint dislocation, Booth and Roper (1979) on operative repair, and newer modalities such as suture anchors (Abiddin et al., 2006), suggest a wide array of treatment options that can be tailored to the specific needs of the patient.

Conclusion and Implications

The clinical narrative of the 50-year-old accident victim’s recovery demonstrates surgery’s potential success. The unique combination of injuries provides an educational foundation for future orthopaedic cases with similar complexities.

References

1. Yadav S. S., Khanna V. V., & Mukherjee S. S. (2019 May-Jun). Ipsilateral sternoclavicular joint anterior dislocation with fracture of the mid shaft of the clavicle. Journal of Clinical Orthopaedics and Trauma, 10(3), 510-513. DOI: 10.1016/j.jcot.2018.08.002

2. Nowak J., Holgersson M., & Larsson S. (2005). Sequelae from clavicular fractures are common: a prospective study of 222 patients. Acta Orthop, 76, 496–502. DOI: 10.1080/17453670510041475

3. Khalid N., Elbeshbeshy, A., Alsaleh, K. A., & Al-Ahaideb, A. (2013). Anterior sternoclavicular dislocation associated with clavicular fracture: a case report and review of the literature. European Journal of Orthopaedic Surgery & Traumatology, 23(Suppl 2), S179–S182. DOI: 10.1007/s00590-012-1098-5

4. Thomas D. P., Williams P. R., & Hoddinott H. C. (2000 Nov). A ‘safe’ surgical technique for stabilization of the sternoclavicular joint: a cadaveric and clinical study. Annals of The Royal College of Surgeons of England, 82(6), 432–435.

5. Paladini P., Pellegrini A., Merolla G., Campi F., & Porcellini G. (2012). Treatment of clavicle fractures. Translational Medicine @ UniSa, 2, 47–58.

Keywords

1. Sternoclavicular Joint Dislocation
2. Clavicle Fracture Treatment
3. Ipsilateral Clavicle Injury
4. Orthopaedic Trauma Recovery
5. Clavicle and SC Joint Surgery