A Method for Open Reduction and Internal Fixation of the Unstable Posterior Sternoclavicular Joint Dislocation

Sternoclavicular joint (SCJ) dislocations are rare injuries, accounting for less than I percent of all traumatic joint dislocations (2). Even though they occur infrequently, prompt diagnosis and treatment are necessary to avoid complications. Anterior dislocations are three to twenty times more common than posterior dislocations according to some studies (7,9). Anterior dislocations are often unstable after reduction but are rarely associated with major complications. Unstable anterior dislocations are typically left in their displaced position without concern for significant sequelae. Posterior dislocations are most often stable after reduction but in rare instances are irreducible or redislocate after a closed reduction. Because of the potential hazards related to compression of vital structures within the superior mediastinum (1,3,4,6,8), open reduction and internal fixation usually are required. However. the optimal method for stabilization of the medial head of the clavicle within the sternal notch remains largely unsolved. We report an effective method for obtaining stable, solid fixation using two large-bore cannulated screws. The large-bore cannulated screws provide superior stability and are not prone 10 catastrophic breakage or migration as has been reported with the use of pins or wires (5). Although we are unaware of prior reports using large-bore cannulated screw means of fixation of the SCJ, these screws have been to fix unstable sacroiliac joint injuries (10), where tremendous forces can be generated during daily activities.