Case Report

Posterior dislocation of the clavicle at the sternoclavicular joint

Abstract

A 27-year-old woman presented to the emergency department after a rollover motor vehicle collision. She complained of right shoulder and upper chest pain worse with movement of the arm. She had marked tenderness over the right clavicle with mild local swelling. There was no bony crepitus, and the result of her neurovascular examination was normal. Radiographs of the right shoulder were normal. The chest radiograph (Fig. 1A) showed the medial head of the right clavicle extending beyond the midline (arrow). Follow- up Computed tomographic angiogram revealed a posterior dislocation of the right clavicle (Fig. 1B and C) at the sternoclavicular joint with 50% compression of the left subclavian vein. The patient was taken immediately to the operating room for reduction. The reduction was achieved by applying traction with the arm abducted 908 and slightly extended while the clavicle was pulled anteriorly with percutaneous towel clips. She was discharged home with a figure-of-8 splint to be worn for 6 weeks.

Posterior dislocations of the clavicle at the sternum are rare, but they can cause significant morbidity and mortality by compromising the great vessels, trachea, esophagus, or lungs [1]. These injuries usually result from trauma to the anterior chest or lateral shoulder [2]. They are difficult to diagnose because swelling and pain can limit the physical

examination, and plain radiographs of the chest often appear normal. Computed tomographic angiogram is the study of choice when posterior sternoclavicular Joint dislocation is suspected [3]. closed reduction is attempted as described. If closed reduction is unsuccessful or if there are mediastinal injuries, open reduction is required.

Daniel P. Stewart MD, FACEP

Michigan State University College of Human Medicine

Kalamazoo, MI, USA Bronson Methodist Hospital, Kalamazoo, MI, USA

Luke H. Van Klompenberg MD Department of Emergency Medicine Michigan State University/Kalamazoo Center for Medical Studies Kalamazoo, MI 49008-1284, USA

E-mail address: [email protected] doi:10.1016/j.ajem.2007.03.021

References

1. Buckerfield MD, et al. Acute traumatic retrosternal dislocation of the clavicle. J Bone Joint Surg Am 1984;66:379 – 85.
2. Cope R. Dislocations of the sternoclavicular joint. Skeletal Radiol 1993;22:233 – 8.
3. Levinsohn EM, et al. Computed tomography in the diagnosis of dislocations of the sternoclavicular joint. Clin Orthop 1979;140:12 – 6.

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108.e4 Case Report

Fig. 1 (A) Plain chest radiograph showing the right clavicle extending beyond the midline (arrow). (B) Coronal and (C) transverse sections from the follow-up CT angiogram revealing a posterior dislocation of the right clavicle at the sternum with 50% compression of the left subclavian vein.