Sternoclavicular Joint Dislocations -

Stability of SC joint
- is provided by joint capsule/costoclavicular & interclavicular ligaments
- very little joint congruity
Medial epiphysis fuses with clavicle at 23-25 years; therefore, injuries in young adults often physeal

usually managed nonoperative with activity modification & reassurance
may do closed reducation
- traction & abduction
- bump between shoulders
- often unsuccessful
- many remain unstable & usually not improved by open intervention
- figure 8 splint for 6 weeks
persistent prominence is usually present but not of functional significance
– atraumatic dislocation
– no specific treatment is required, as the natural history is relatively good
– traumatic dislocation: some patients may have pain & loss of function

may require treatment because of proximity of major neurovascular structures & airway
closed reduction
- thorough vascular exam preop including CT scan to assess vascular injury & proximity
- under GA in operating room
- chest / vascular / cardiothoracic surgeon available to address any potential vascular or airway catastrophe associated with injuries to the mediastinum
- Use abduction & traction & towel clip
- Successful closed reduction usually stable
- avoid Internal fixation because of likelihood of hardware migration & possible injury to the mediastinal structures
- If closed reduction unsuccessful, open reduction is indicated

should generally be left alone to remodel
if symptomatic & posterior
- then closed reduction can be done
Posterior dislocations require pre-op CT to assess vascular injury, & these require CR under GA with vascular notification

Recurrent instability uncommon
Many apparent dislocations in adolescents may be growth plate injuries that will remodel without treatment