Introduction: Posterior sternoclavicular (PSC) dislocations are rare events, most commonly occurring after high energy injury such as motor vehicle accident or contact sports. While rare, PSC dislocations can be life threatening due to risk of posterior displacement of the medial clavicle impinging the great vessels leading to the heart. As such, patients with sternoclavicular dislocation are at risk for intimal tears and hemorrhage. Traditional orthopedic surgery teachings state closed reductions for PSC dislocation should have cardiothoracic (CT) surgeons on standby in the event intimal tears need repair. Despite this, there lacks conclusive evidence and literature about whether CT surgeon standby is truly necessary. This study assesses the incidence of need for CT or vascular surgery following posterior dislocation of the sternoclavicular joint.
Methods: Using a national deidentified database, TriNetX, a retrospective observational study of all pediatric (age < 21) patients (N=224) who were diagnosed with a posterior sternoclavicular dislocation from 2015 to current time was conducted. From the patients identified, an outcome analysis was performed to calculate the percent of those patients who required surgical procedures on the heart and pericardium (CPT: 1006057) or surgical procedures on arteries and veins (CPT: 1006359) within 90 days of dislocation. Vascular introduction and injection procedures (CPT: 1013922) were not included in this outcome analysis. Additionally, all patients with previous surgical procedures of the heart or pericardium and arteries and veins were excluded from the study.
Results: Outcome analysis revealed a 4.464% (10 patients) risk for either surgical procedure on the heart and pericardium or surgical procedures on arteries and veins. Of the ten patients with this outcome, all ten required endovascular repairs of the descending thoracic aorta.
Discussion and Conclusion: While rare, cardiovascular injury following PSC dislocation is a potential life-threatening complication. Having the immediate intervention of CT surgeons following such injuries may be a vital, life-saving consideration. As such, traditional teaching of having CT surgeons on standby for closed reduction is supported. Additional research is required to identify the severity of cardiovascular injury following PSC dislocation.
Summary: A retrospective review assessing the incidence of cardiovascular complications in 224 pediatric posterior sternoclavicular dislocations. The aim is to establish the need for CT surgeon standby.
