Objective To investigate the short-term effectiveness of reconstructive locked plate for treating sternoclavicular joint dislocation. Methods Between February 2008 and February 2012, 11 patients with sternoclavicular joint dislocation were treated with reconstructive locked plate, and the clinical data were retrospectively analyzed. There were 7 males and 4 females, aged 30-55 years (mean, 44 years). The causes of injury included traffic accident in 8 cases and crashing in 3 cases. The disease duration ranged from 2 hours to 11 days (median, 6 days). All patients had anterior dislocation of sternoclavicular joint. According to the Grade system, there were 2 cases of type II and 9 cases of type III. Results All patients obtained healing of incisions by first intention after operation. There was no neurovascular injury. The X-ray films showed that satisfactory reduction of joint dislocation and stable internal fixation were obtained at 2 days after operation. All patients were followed up 9-24 months (mean, 16 months). According to the Rockwood criteria, the score was 10-15 (mean, 13.2); the results were excellent in 9 cases and good in 2 cases, with an excellent and good rate of 100% at 9 months after operation. No internal fixation failure or re-dislocation occurred. All internal fixators were removed at 9-15 months after operation. Both the stability and the functions of the shoulder joint were good. Conclusion The reconstructive locked plate in treating sternoclavicular joint dislocation has the advantages of good stability and satisfactory reduction, and the patients can do functional exercises early and obtain good recovery of the shoulder joint function. The short-term effectiveness is satisfactory.
Objective To analyze the treatment of the sternoclavicular joint dislocation by clavicular hook plate and investigate its cl inical value to find a theropy with more safety and stabil ity. Methods Between January 2003 and January 2007, 15 patients with sternoclavicular joint dislocation were involved, among whom there were 12 males and 3 females, aged 28-45 years old (34 on average). There were 12 cases of fall ing injury and 3 cases of vehicle accident injury. The course of disease was 1-12 hours. A total of 2 cases were on the left side and 13 were on the right side. There were 14 casesof anterior dislocation and 1 of posterior dislocation. Two patients were compl icated by acromioclavicular joint dislocationwith no pneumothorax, and 2 patients had a l ittle pleural effusion without any special treatment. As to the damage degree,according to the Grade system, there were 2 cases of type II and 13 cases of type III. Results All patients’ incisionsobtained heal ing by first intention after operation. The X-ray films showed that the reduction of joint dislocation and thelocation of internal fixation were good. All the 15 patients were followed up for 6-18 months (14 months on average). All cases were scored by Rockwood after the operation to assess the curative effect, with 12 excellent, 2 good and 1 fair. There was no wound infection, neurovascular injury, hemopneumothorax, internal fixation failure, redislocation or other side injuries. The anatomical structure as well as appearances and functions were restored. Conclusion The fixation of clavicular hook plate in treating ternoclavicular joint dislocation has superiority over other methods with more stabil ity, less risk and small chances of cardiovascular injury. Besides, the patients can do functional exercises early and the shoulder joint function can be improved to the maximal degree.
ObjectiveTo summarize the research progress in the surgical treatment of sternoclavicular joint dislocation. MethodThe literature on the treatment of sternoclavicular joint dislocation was reviewed, summarized, and analyzed. ResultsAt present, the main therapy of sternoclavicular joint dislocation is operation, including the sternoclavicular joint reconstruction, the inner end of the clavicle resection, and internal fixation of the sternoclavicular joint. The internal fixation surgery is the preferred way, which is reliable fixation and in favor of early functional exercise. ConclusionsIt is the current focus of attention to select a reliable fixation that is accord with sternoclavicular joint anatomy and biomechanics.
Objective To develop an anatomical locking plate in accordance with the anatomical characteristics of the sternoclavicular joint, which is reliable fixation and easy to operate, so as to provide an ideal internal fixation device for the treatment of sternoclavicular joint dislocation or peripheral fractures. Methods Gross measurement and CT measurement were performed on the 8 adult antiseptic and moist cadaver specimens (16 sides) to measure the parameters of surrounding bone structure of the sternoclavicular joint. The parameters included the thickness of presternum, sternal notch width, anteroposterior diameter of proximal 1/3 of clavicle, upper and lower diameters of proximal 1/3 of clavicle, angle between proximal end of clavicle and presternum in coronal plane, and angle of thoracoclavicular joint at anatomic position forward. According to the anatomical parameters and biomechanical properties of the specimens, the anatomical locking plate was designed and developed. The sternoclavicular ligament and joint capsule of all the specimens were completely cut off to make the sternoclavicular joint dislocation model. The left and right sternoclavicular joint of each specimen were randomly divided into experimental group (anatomic locking plate fixation) and control group (oblique T shape locking plate fixation). The sternoclavicular joint activity and common force mechanism was simulated on the universal mechanical testing machine, and the clavicular distal load test, sternoclavicular joint torsion test, and anti-pulling of steel plate manubrium part test were performed. Results The differences between the anatomical parameters of gross measurement and CT measurement were not significant (P>0.05). In the clavicular distal load test, when the anatomical position perpendicular to the distal clavicle back loading to 20 N, the displacement of loading point in the experimental group was (8.455±0.981) mm, which was significantly less than that in control group [(10.163±1.379) mm] (t=–3.012,P=0.020); the distal clavicle displacement of loading point of experimental group and control group were (5.427±1.154) mm and (6.393±1.040) mm, respectively, showing no significant difference (t=–1.459, P=0.188). In the sternoclavicular joint torsion test, the torque of experimental group was significantly greater than that of control group when the clockwise torsion angle was at 2, 4, 6, 8, and 10 degrees and the counterclockwise torsion angle was at 4, 6, 8, and 10 degrees (P<0.05). The torsional stiffness in the experimental group under clockwise and counterclockwise condition was 0.122 and 0.108 N·m/° respectively, which were significantly higher than those in the control group (0.083 and 0.078 N·m/° respectively) (F=67.824, P=0.000; F=20.992, P=0.002). In the anti-pulling of steel plate manubrium part test, the maximum pullout force of experimental group [(225.24±16.02) N] was significantly higher than that in control group [(174.40±21.90) N] (t=5.785, P=0.001). Conclusion The new type of anatomical locking plate can realize the sternoclavicular joint three-dimensional fixation, and has the advantages of reliable fixation, simple operation, less trauma, superior biomechanical properties, and earlier functional exercise. It may be an ideal internal fixation device in clinical treatment of sternoclavicular joint dislocation or peripheral fractures.
ObjectiveTo report a new type of anatomical locking plate for sternocalvicular joint, and investigate its effectiveness in treatment of sternoclavicular joint fracture and dislocation.MethodsA new type of anatomical locking plate for sternoclavicular joint was developed, which accorded with the anatomical features and biomechanical characteristics of Chinese sternoclavicular joint. By adopting the method of clinical randomized controlled study, 32 patients with the sternoclavicular joint fracture and dislocation who met the selection criteria between June 2008 and May 2015 were randomly divided into groups A and B (n=16), and the patients were treated with new anatomic locking plate and distal radial T locking plate internal fixation, respectively. There was no significant difference between 2 groups in gender, age, injured side, body mass index, cause of injury, type of injury, the time from injury to operation, and preoperative Rockwood grading score (P>0.05). The operation time, intraoperative blood loss, incision length, hospitalization time, and postoperative complications in 2 groups were recorded, and the effectiveness was evaluated by Rockwood grading score.ResultsThe operations of 2 groups completed successfully. The operation time, intraoperative blood loss, and hospitalization time in group A were significantly less than those in group B (P<0.05), but there was no significant difference in the incision length between 2 groups (t=0.672, P=0.507). All the patients were followed up 18-30 months (mean, 24 months). In group A, there were 1 case of sternoclavicular joint pain and 2 cases of wound infection; in group B, there were 1 case of sternoclavicular joint pain, 1 case of internal fixation loosening, and 1 case of sternoclavicular joint re-dislocation; there was no significant difference in complication incidence between 2 groups (P=1.000). The Rockwood grading scores at each time point after operation in 2 groups were significantly higher than those before operation. At 1 month after operation, the Rockwood grading score in group A was significantly higher than that in group B (t=2.270, P=0.031); but there was no significant difference in the Rockwood grading scores between the 2 groups at 6 months and at last follow-up (P>0.05). At last follow-up, according to the Rockwood scoring standard, the results of group A were excellent in 13 cases, good in 2 cases, poor in 1 case, the excellent and good rate was 93.75%; the results of group B were excellent in 11 cases, good in 4 cases, poor in 1 case, and the excellent and good rate was 93.75%; there was no significant difference between 2 groups (Z=–0.748, P=0.455).ConclusionThe new type of anatomic locking plate accords with the Chinese anatomical characteristics. It has the advantages of easy operative procedure, less surgical trauma, shorter operation time, less intraoperative blood loss, shorter hospitalization time, and it can achieve better results in the treatment of sternoclavicular joint fracture and dislocation.
The sternoclavicular joint is located at the cervicothoracic junction, where various types of lesions such as trauma, infection, inflammation and tumor can occur. Complex chest wall reconstruction involving the sternoclavicular joint occurs from time to time. Whether and how to reconstruct the sternoclavicular joint is a difficult problem for surgeons. At present, there is no unified standard for sternoclavicular joint resection and reconstruction. There are many materials and methods for sternoclavicular joint reconstruction. With the development of surgical techniques and treatment concepts, we have a new understanding of the anatomy, function, and surgical treatment of the sternoclavicular joint. This article primarily provides an overview of these developments.