Fixation of proximal clavicle and sternum through the intramedullary cavity for sternoclavicular joint dislocation with wire rope:an anatomic and clinical research / 中国组织工程研究

ABSTRACT

BACKGROUND:Surgical management of sternoclavicular joint dislocation takes relatively larger risks for its adjacent mediastinal and other important structures. However, the surgical methods are varied and remain controversial. OBJECTIVE:To investigate the feasibility and validity of intramedul ary fixation of the proximal clavicle and sternum for sternoclavicular joint dislocation. METHODS:On 22 adult cadaver upper limb specimens, the anatomical features of the sternoclavicular joints and associated ligaments, the size of articular surface between the medial clavicle and manubrium and the morphology of articular disc, costoclavicular ligament and sternoclavicular ligament were observed and measured. From January 2009 to July 2012, three patients with sternoclavicular joint dislocation received the intramedul ary fixation with wire rope or absorbable suture in figure-of-eight shape. They were males, aged 9, 45 and 62 years, with an average age of 38.6 years. The outcome was evaluated by upper limb function DASH score. RESULTS AND CONCLUSION:Anatomic results demonstrated that the anteroposterior and coronal diameters of the surface of the medial clavicle were greater than that of the sternum, so they did not match each other. The minimum thickness of the manubrium sterni was at the superior margin of articular surface and the largest was at the sternal angle. The minimum width of the manubrium sterni was at the superior margin of articular surface and the largest was at the inferior margin. The articular disc, liked an el ipse and matched with the articulating surface of the manubrium sterni more, whose anteroposterior diameter was greater than its coronal diameter. Central thickness was greater than the edge thickness. The costoclavicular ligament was thicker and denser than the anterior and posterior sternoclavicular ligament. The anterior and posterior sternoclavicular ligaments were close in length, width and thickness. Clinical trial results demonstrated that al cases were fol owed up for 14 to 36 months. DASH score was 10-16, 13.3 in average. Effects of internal fixation were satisfactory. Surgical management of sternoclavicular joint dislocation by the fixation of the proximal clavicle and sternum through the intramedul ary cavity with wire rope or absorbable suture is reliable and effective.