Die sternoklavikuläre Luxation

 

 Buy Article Permissions and Reprints

Zusammenfassung

Hintergrund: Sternoklavikuläre Verletzungen sind selten. Wahrscheinlich werden sie auch häufig nicht erkannt. Nicht reponierte Luxationen und Luxationsfrakturen können demgegenüber zu erheblichen Beschwerden führen. Methode: Fünf Patienten mit sternoklavikulären Verletzungen wurden erfasst. Zwei Patienten wurden operiert, bei 1 Patienten wurde die Luxation in Narkose reponiert, 2 Patienten wurden konservativ behandelt. Ergebnisse: Bei allen Patienten führte die Therapie zu Beschwerdefreiheit mit symmetrischer Armfunktion. Schlussfolgerung: Sternoklavikuläre Verletzungen sind selten und werden meistens konservativ mit Erfolg therapiert. Irreponible Luxationen und Luxationsfrakturen müssen operativ versorgt werden. Bei Subluxationen sollte die Indikation für ein operatives Vorgehen aufgrund der anatomischen Verhältnisse und entsprechender Gefährdung v. a. vaskulärer Strukturen vorsichtig gestellt werden.

Abstract

Introduction: Injuries of the sternoclavicular joint are rare. Probably these injuries are frequently missed. Distorsion type lesions mostly heal uneventfully. Their diagnosis and treatment may be demanding. Untreated, a dislocation of the sternoclavicular joint and dislocation fractures may lead to considerable discomfort or even a risk for neurovascular damage. This work focuses on the anatomy and lesions of the sternoclavicular joint, the pathomechanism of the injury and the treatment options according to our acute trauma-patient collective. Method: Five patients with sternoclavicular impairment have been assessed. Radiological evaluation consisted in standard chest X-rays. In the situation of a fracture and/or complete luxation, CT scans of the sternoclavicular joints were additionally performed. Two of our patients underwent surgery (one osteosynthesis with a plate and one reduction and ligament reconstruction were performed), in one case dislocation was reduced in a closed way in a short-lasting general anaesthesia and in two cases conservative treatment was performed. Results: In all cases the chosen treatment protocol led to symmetrical arm function and all patients were pain-free 2 to 6 months after the injury. In one patient the plate was removed 4 months after osteosynthesis. Conclusion: Distorsions of the sternoclavicular joints are probably underdiagnosed and often mildly symptomatic. Conservative treatment usually leads to satisfying functional results with significant pain reduction. Non-reducible dislocations and dislocation fractures have to be treated operatively. Many different open procedures have been described, such as ligament reconstructions and osteosynthesis. The postoperative results are generally good, but operative treatment may be difficult and at risk for complications. Indications for operative treatment of joint subluxation should be strictly limited because of the high risk of accompanying neurovascular impairment during manipulation and fixation.

Literatur

• 1 Allman Jr F L. Fractures and ligamentous injuries of the clavicle and its articulation.  J Bone Joint Surg [Am]. 1967;  49 774-784
  PubMedGoogle Scholar
• 2 Armstrong A L, Dias J J. Reconstruction for instability of the sternoclavicular joint using the tendon of the sternocleidomastoid muscle.  J Bone Joint Surg [Br]. 2008;  90 610-613
  CrossrefPubMedGoogle Scholar
• 3 Burrows H J. Tenodesis of subclavius in the treatment of recurrent dislocation of the sterno-clavicular joint.  J Bone Joint Surg [Br]. 1951;  33 240-243
  PubMedGoogle Scholar
• 4 Dennis M G, Kummer F J, Zuckermann J D. Dislocations of the sternoclavicular joint.  Bull Hosp Jt Dis. 2000;  59 153-157
  PubMedGoogle Scholar
• 5 Eskola A, Vainionpää S, Vastamäki M et al. Operation for old sternoclavicular dislocation. Results in 12 cases.  J Bone Joint Surg [Br]. 1989;  71 63-65
  PubMedGoogle Scholar
• 6 Haas N, Blauth M. Verletzungen des Acromio- und Sternoclaviculargelenkes – Operative oder konservative Behandlung?.  Orthopäde. 1989;  18 234-245
  PubMedGoogle Scholar
• 7 Jaggard M, Wallace W A. Sterno-clavicular joint stability: clinical observations, biomechanical testing and options for improving surgical stabilisation.  J Bone Joint Surg [Br]. 2008;  90 (Suppl. II) 358
  PubMedGoogle Scholar
• 8 Kapandji I A. Funktionelle Anatomie der Gelenke, Band 1: Obere Extremität.. Stuttgart: Hippokrates; 1999: 44
  Google Scholar
• 9 Petrovitch A, Mückley T, Böttcher J et al. Die habituelle vordere Luxation des Sternoklavikulargelenkes – bildgebende Funktionsdiagnostik und funktionelle Morphologie.  Fortschr Röntgenstr. 2006;  178 1028-1036
  Article in Thieme ConnectPubMedGoogle Scholar

Dr. med. Daniel Weber

Orthopädie/Traumatologie
St. Claraspital

Kleinriehenstr. 30

4058 Basel

Schweiz

Phone: +41/61/6 85 84 90

Fax: +41/61/6 85 86 57

Email: daniel.weber@claraspital.ch