Published online Apr 18, 2016. doi: 10.5312/wjo.v7.i4.244
Peer-review started: June 1, 2015
First decision: August 16, 2015
Revised: December 11, 2015
Accepted: January 5, 2016
Article in press: January 7, 2016
Published online: April 18, 2016
Dislocations of the sternoclavicular joint (SCJ) occur with relative infrequency and can be classified into anterior and posterior dislocation, with the former being more common. The SCJ is inherently unstable due to its lack of articular contact and therefore relies on stability from surrounding ligamentous structures, such as the costoclavicular, interclavicular and capsular ligaments. The posterior capsule has been shown in several studies to be the most important structure in determining stability irrespective of the direction of injury. Posterior dislocation of the SCJ can be associated with life threatening complications such as neurovascular, tracheal and oesophageal injuries. Due to the high mortality associated with such complications, these injuries need to be recognised acutely and managed promptly. Investigations such as X-ray imaging are poor at delineating anatomy at the level of the mediastinum and therefore CT imaging has become the investigation of choice. Due to its rarity, the current guidance on how to manage acute and chronic dislocations is debatable. This analysis of historical and recent literature aims to determine guidance on current thinking regarding SCJ instability, including the use of the Stanmore triangle. The described methods of reduction for both anterior and posterior dislocations and the various surgical reconstructive techniques are also discussed.
Core tip: Most anterior sternoclavicular joint (SCJ) dislocations can be managed non-surgically. A small subgroup of these patients develop persistent symptomatic anterior instability. While most tolerate these symptoms well some find this disabling and surgical stabilisation in such cases have shown satisfactory results. Posterior SCJ dislocation can be subtle and needs prompt identification and immediate closed reduction but if unstable will require surgical stabilisation.