Treatment strategy for septic arthritis of the sternoclavicular joint with osteomyelitis, large abscesses, and mediastinitis: A case report

Abstract

Introduction and importance

Septic arthritis of the sternoclavicular joint (SASCJ) accounts for <1 % of all joint infections. Owing to the limited literature on the disease, there is no consensus on the general treatment for SASCJ. Here, we report a case of SASCJ complicated by osteomyelitis, mediastinitis, infectious myositis, and cervical and chest wall abscesses that required radical sternoclavicular joint resection and reconstruction using the greater omental flap. In this report, we discuss the treatment strategy for advanced SASCJ cases.

Case presentation

A 65-year-old man was diagnosed with SASCJ relapse after the failure of antibiotic therapy alone, combined with osteomyelitis, mediastinitis, infectious myositis, and cervical and chest wall abscesses. A radical sternoclavicular joint resection was performed. After negative-pressure wound therapy, serial re-debridement was performed. The greater omental flap was transported into a deep, large residual space. The patient has been relapse-free for 1 year.

Clinical discussion

Radical resection of the entire sternoclavicular joint should be the preferred management strategy for patients with sternoclavicular joint infections, especially in cases of osteomyelitis. Although the pectoralis major flap is typically the first choice to cover the defect, we used the omental flap because the locoregional flaps were not large enough to reconstruct the defect.

Conclusion

The greater omental flap is an advantageous alternative when there is a need to provide coverage for large defects in cases of SASCJ.