Abstract:Background Sternoclavicular joint (SCJ) injuries are rare, representing less than 5% of shoulder girdle injuries. In adolescents, the unfused medial clavicular physis predisposes to physeal fracture-dislocations ("pseudodislocations"). Ipsilateral SCJ disruption with clavicle fracture is exceptionally uncommon, with few cases reported. Case Presentation A 15-year-old male presented following a high-speed rollover road traffic accident. He was hemodynamically stable and reported isolated pain in the left shoulder. Radiographs and CT angiography revealed an anterior SCJ disruption with an associated medial clavicle fracture. The medial fragment was rotated 90° in the coronal plane without evidence of great vessel compromise. Intervention Open reduction and internal fixation of the medial clavicle fracture were performed via a superior approach, with protection of the medial supraclavicular nerve. Anatomical reduction was achieved and stabilized with a superiorly placed 2.7 mm reconstruction plate and three bicortical screws on each side. Reduction of the fracture restored SCJ alignment without direct fixation of the joint. Outcome Postoperative management included sling immobilization for one week, followed by progressive mobilization. At one week, forward flexion was 90°. By six weeks, the patient achieved near-complete range of motion, and at three months had full, symmetrical shoulder mobility. At six months, he was asymptomatic, radiographs confirmed union, and SCJ congruity was maintained. Conclusion: Ipsilateral SCJ disruption with clavicle fracture is rare, particularly in adolescents. In our case, open reduction and rigid fixation of the medial clavicle using a reconstruction plate achieved stable SCJ alignment without direct joint fixation and resulted in complete functional recovery. This case adds to the limited literature and supports rigid clavicular fixation as a safe and effective treatment option for similar high-energy injuries in skeletally immature patients.
Alabdali et al. (Sun,) studied this question.