Sterno-Clavicular Joint: Modern Surgery Dive In ! Michael D. - - PowerPoint PPT Presentation

Sterno-Clavicular Joint: Modern Surgery – Dive In !

• Michael D. McKee, MD, FRCS(C)
• Professor and Chair, Department of Orthopaedic Surgery
• University of Arizona, College of Medicine, Phoenix, AZ

Disclosure

• Studies supported by:
• OTA, COA, ASES
• Zimmer Inc.
• Stryker, Olympus Biotech, AO
• I am a consultant for Stryker, Acumed,

Zimmer, ITS

• Receive royalties from Stryker (plates),

LWW, Springer (publishers)

Sterno-clavicular Injuries These injuries are classified by:

Direction of the dislocation

anterior or posterior

Chronicity

acute, sub-acute, or chronic

Severity

capsular sprains subluxations Dislocations Associated fractures

Traditional Treatment

• What we said was that outcome was “ ….generally

good….little disability…” if left alone

• What we should have said was: this will be a

problem for you but:

– We are afraid to operate in this area – I never saw a case when I was training – We didn’t really have a reliable operation for SC instability

Treatment in 2017

Decide that you want to be the one doing this Closed Reduction – current standard of care – Reduction under local or general anesthesia – Patient Supine – 60% success anterior, 35% success posterior Open Reduction – If closed reduction fails, in appropriate cases – CV surgeon available

• 17 year old male, ATV accident

Semitendinosus graft in a figure-of-eight

I do not operate on the female adolescent with voluntary, atraumatic, subluxation or “clunking” of the SC joint Acute injuries with frank dislocations should be reduced Most subluxations can be treated non-operatively Closed reduction if possible, open reduction if necessary (I use plates and screws in general) with a CV surgeon available