Elbawab Hatem, Aljehani Yasser, AlReshaid Farouk T, Almusabeh Hamza Ali, Al-Harbi Turki Muslih, Alghamdi Rizam
Thoracic Unit, Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
Thoracic Unit, Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
Int J Surg Case Rep. 2020;77:426-429. doi: 10.1016/j.ijscr.2020.10.135. Epub 2020 Nov 4.
Sternoclavicular joint (SCJ) osteomyelitis is a very rare condition. Here, we report an uncommon case of a complicated SCJ osteomyelitis in a patient with an anterior chest wall trauma.
A 61-year-old male a known case of dyslipidemia, hypertension (HTN), and type II diabetes mellitus (T2DM). The patient presented with pain and erythema over the right SCJ following trauma to the same location. Two weeks later, the patient presented with erythematous swelling with a sinus discharging pus, although he was discharged on oral antibiotics, analgesics, and had underwent an incisional drainage. Computerized Tomography (CT) of the chest showed fluid collection surrounding the right SCJ together with joint effusion suggestive of SCJ osteomyelitis. The patient underwent initial debridement and a definitive bone resection with pectoralis muscle flap two weeks following. Five months later, the patient was seen in the outpatient clinic, the wound was completely healed, and he has a normal function of the right arm.
The management of SCJ osteomyelitis is not well established, yet it can be approached medically, surgically, or both.
Surgical intervention is indicated in cases of SCJ osteomyelitis after the failure of antibiotic therapy trial. This is especially the case in the presence of abscess and bone destruction. SCJ debridement followed by delayed resection and pectoralis muscle flap might offer better results than merely debridement alone or with resection of the joint.
胸锁关节（SCJ）骨髓炎是一种非常罕见的病症。在此，我们报告一例因前胸壁创伤导致的复杂胸锁关节骨髓炎的罕见病例。
一名61岁男性，已知患有血脂异常、高血压（HTN）和II型糖尿病（T2DM）。该患者在右胸锁关节同一部位受伤后出现疼痛和红斑。两周后，患者出现红肿并有一个排出脓液的窦道，尽管他已接受口服抗生素、镇痛药治疗并进行了切开引流。胸部计算机断层扫描（CT）显示右胸锁关节周围有积液以及提示胸锁关节骨髓炎的关节积液。患者在两周后首先接受了清创术，随后进行了带胸大肌瓣的确定性骨切除术。五个月后，患者在门诊复诊，伤口已完全愈合，右臂功能正常。
胸锁关节骨髓炎的治疗方法尚未完全确立，但可采用药物治疗、手术治疗或两者结合的方式。
在抗生素治疗试验失败的胸锁关节骨髓炎病例中，应进行手术干预。在存在脓肿和骨质破坏的情况下尤其如此。胸锁关节清创术，随后进行延迟切除术和胸大肌瓣修复可能比单纯清创术或关节切除术能取得更好的效果。
