JBJS - 2026-05-07 - Journal Article
Advances in the Management of Sternoclavicular Joint Injuries.
Nielsen C, Dehghan N, McKee MD
Topics
Key Takeaway
Acute posterior SCJ dislocations treated with prompt reduction and ligament reconstruction yield reliable outcomes, while chronic locked posterior dislocations carry substantially higher surgical complexity and complication risk.
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Summary
This narrative review synthesizes current evidence on diagnosis, imaging, and surgical management of sternoclavicular joint injuries, emphasizing the urgency of reducing acute posterior dislocations in active patients and the technical challenges of chronic locked posterior dislocations. CT is the primary imaging modality; CT angiography is indicated when vascular injury is suspected given proximity of the brachiocephalic veins and mediastinal structures. Ligament reconstruction and ORIF are supported by the existing literature as reliable surgical options.
Key Limitation
The absence of pooled outcome data or a systematic search strategy means recommendations are expert-consensus level and cannot quantify complication rates or functional outcomes for specific surgical techniques.
Original Abstract
➢ The sternoclavicular joint (SCJ) serves as the only osseous connection between the axial skeleton and the upper limb and is a synovial, saddle-like joint with robust posterior ligamentous stabilizers and a fibrocartilaginous disc.➢ The brachiocephalic veins and other mediastinal structures are at risk from injury or surgery about the SCJ.➢ SCJ injuries are best imaged with computed tomography (CT). CT angiography is warranted when a vascular injury is suspected, and magnetic resonance imaging (MRI) is useful to define soft-tissue injuries.➢ Acute posterior SCJ dislocations in active, healthy individuals can result in considerable disability if unreduced and an aggressive treatment approach is warranted.➢ Chronic locked posterior dislocations are more challenging to treat, making prompt recognition and referral (if appropriate) important.➢ Reliable surgical techniques including ligament reconstruction and open reduction and internal fixation for SCJ injuries have been well supported in the current orthopaedic literature.➢ Vascular injury is a rare but catastrophic concern when dealing with SCJ pathology and should be considered when determining the venue for planned intervention, as should collaboration with a thoracic or vascular surgeon.