Koch Matthew J, Wells Lawrence
University of Pennsylvania School of Medicine, USA.
Orthopedics. 2012 Jan 16;35(1):e108-11. doi: 10.3928/01477447-20111122-39.
Posterior sternoclavicular fracture displacement can present as a posterior sternoclavicular joint dislocation and is rare in the pediatric population. This article provides an algorithm for evaluation and management.A 14-year-old boy with a previously undiagnosed posterior sternoclavicular displacement presented with persistent 7/10 shoulder pain extending into his neck after undergoing nonoperative treatment for an unconfirmed diagnosis at another emergency department. Plain radiographs revealed a displacement of the right medial clavicle, and the position of the clavicular head indicated advanced imaging. Computed tomography showed the posterior portion of the clavicular head butting against the left braciocephalic vein at its confluence with the superior vena cava. The patient underwent open reduction and internal fixation. After exposing the sternoclavicular joint, a Salter-Harris I fracture with no evidence of vascular injury was confirmed. The fracture was reduced and stabilized using figure-eight #5 Ethibond sutures (Ethicon, Somerville, New Jersey), and the patient was placed in an immobilizer for 1 week. At 1 year postoperatively, the patient regained full range of motion and was completely healed.Posterior clavicle displacements are potentially devastating injuries that are difficult to diagnose. Coordinating operative treatment with orthopedic and general surgery is indicated to manage the fracture or displacement and potential vascular injury. Due to difficulties in maintaining a closed reduction, open reduction and internal fixation is the preferred mode of treatment for the reduction of all posterior clavicular fracture displacements.
胸锁关节后脱位可表现为胸锁关节后脱位，在儿科人群中较为罕见。本文提供了一种评估和处理的方法。一名14岁男孩，之前未被诊断出胸锁关节后脱位，在另一家急诊科因未确诊而接受非手术治疗后，出现持续的肩部疼痛（疼痛程度为7/10）并放射至颈部。X线平片显示右锁骨内侧移位，锁骨头部位置提示需进一步影像学检查。计算机断层扫描显示锁骨头部后部在与上腔静脉汇合处抵靠左头臂静脉。患者接受了切开复位内固定术。暴露胸锁关节后，确认是Salter-Harris I型骨折，无血管损伤迹象。使用8字缝合的5号Ethibond缝线（Ethicon公司，新泽西州萨默维尔）对骨折进行复位和固定，患者佩戴固定器1周。术后1年，患者恢复了全关节活动范围，骨折完全愈合。锁骨后移位是潜在的严重损伤，难以诊断。对于骨折或移位以及潜在的血管损伤，需要骨科和普通外科协作进行手术治疗。由于难以维持闭合复位，切开复位内固定是治疗所有锁骨后脱位的首选方法。
