Chotai Pranit N, Ebraheim Nabil A
Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, Ohio 43614, USA.
Orthopedics. 2012 Oct;35(10):e1542-7. doi: 10.3928/01477447-20120919-27.
Posterior sternoclavicular dislocation is an uncommon injury and often remains initially undiagnosed due to variable clinical presentation and inadequate visualization of the joint on plain radiographs. It is frequently associated with serious and life-threatening injuries involving the trachea, esophagus, or great vessels. A 15-year-old boy was knocked to the ground during wrestling and landed on his left shoulder. He presented 6 days after trauma with increasing arm swelling and pain. A Doppler ultrasound revealed deep vein thrombosis involving the left shoulder and arm. Contrast-enhanced computed tomography of the chest confirmed the diagnosis of left posterior sternoclavicular dislocation with the medial end of left clavicle compressing the underlying brachiocephalic vein. Venous duplex scan confirmed acute venous thrombosis of the left jugular and subclavian veins. Open reduction of the left posterior sternoclavicular dislocation was performed under general anesthesia with cardiothoracic surgery backup. The reduced joint was stable, negating the need for internal fixation. Postoperatively, the pain and arm swelling gradually subsided, and patient recovered well with no complications. Deep vein thrombosis has not been reported as a presenting symptom for posterior sternoclavicular dislocation. Orthopedic, trauma, and thoracic surgeons should be aware of this presentation and obtain a chest computed tomography scan with 3-dimensional reconstruction to confirm the diagnosis. In cases of posterior sternoclavicular dislocation with vascular compromise, patients should immediately undergo open reduction with or without internal fixation.
胸锁关节后脱位是一种罕见的损伤，由于临床表现多样且普通X线片对该关节的显示不充分，最初常难以诊断。它常与涉及气管、食管或大血管的严重且危及生命的损伤相关。一名15岁男孩在摔跤时被撞倒在地，左肩着地。受伤6天后，他因手臂肿胀和疼痛加剧前来就诊。多普勒超声显示左肩部和手臂深静脉血栓形成。胸部增强计算机断层扫描证实为左胸锁关节后脱位，左锁骨内侧端压迫其下方的头臂静脉。静脉双功扫描证实左颈静脉和锁骨下静脉急性血栓形成。在有胸心外科支持的全身麻醉下对左胸锁关节后脱位进行了切开复位。复位后的关节稳定，无需内固定。术后，疼痛和手臂肿胀逐渐消退，患者恢复良好，无并发症。深静脉血栓形成尚未被报道为胸锁关节后脱位的首发症状。骨科、创伤科和胸外科医生应了解这种表现，并进行胸部计算机断层扫描三维重建以确诊。对于伴有血管受压的胸锁关节后脱位病例，患者应立即接受切开复位，可选择或不选择内固定。
