Posterior sternoclavicular dislocation in childhood – a case report about a rare injury

Abstract

Sternoclavicular dislocation is a rare injury, especially in the pediatric population. These injuries are distinguished based on the direction of the dislocation, among which posterior dislocation is the most dangerous, mainly due to the proximity of vasculature and the trachea. Because of this, quick diagnosis and appropriate management are crucial in the treatment.

Our report is about a 14-year-old boy, who was brought to our department after his friend twisted his arm and pulled it behind his back. The child had pain in the clavicular region, and with thorough examination, the medial end of the clavicle was not palpable as normally. Point-of-care ultrasound helped us with the diagnosis, and after X-ray, a CT scan was performed to visualize the location of the medial end of the clavicle relative to the vasculature and the trachea. The child underwent surgery, where the attempt of closed reduction was unsuccessful, so the operating trauma specialist opted for open reduction, and the fixation with a figure-of-eight suture. The postoperative days went uneventfully, and the child's full range of motion was acquired again after a few months.

In case of posterior sternoclavicular dislocation, early diagnosis and thorough examination are crucial not just to plan the treatment, but also to avoid further, potentially life-threatening complications. In many cases closed reduction can be performed successfully, but in some instances open reduction and internal fixation is inevitable. With appropriate treatment and physiotherapy, the full range of motion can be achieved quickly in the pediatric population.