JSES - 2026-03-16 - Journal Article
The incidence of retrosternal vascular injuries following acute traumatic posterior sternoclavicular joint injuries is significantly less than had previously been considered.
Tytherleigh-Strong G, Winterbottom A, Donaldson M
Topics
Key Takeaway
CTA within 24 hours of acute posterior sternoclavicular joint injury demonstrated zero vascular injuries (0/24 patients), challenging the historically cited ~30% incidence of associated retrosternal vascular injury.
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Summary
This study prospectively evaluated the incidence of retrosternal vascular injury in 24 patients with acute posterior SCJ injuries (16 dislocations, 8 Salter-Harris 2 medial clavicle fractures) using CTA within 24 hours of admission. No vascular injuries, pseudoaneurysms, or active hemorrhage were identified on CTA in any patient; 13 patients had brachiocephalic vein compression and 1 had aortic arch compression, but these were non-injurious. At mean 77.8-month follow-up, functional outcomes were excellent (mean Quick-DASH 2.0, Modified Constant 96.7, SANE 98.7), and no patient reported mediastinal or vascular sequelae.
Key Limitation
The 24-patient cohort, accumulated over 7.5 years at a single center, is underpowered to exclude a low but clinically meaningful vascular injury rate (e.g., 5–10%), and selection bias cannot be excluded if hemodynamically unstable patients were diverted before enrollment.
Original Abstract
INTRODUCTION
It has previously been considered that approximately 30% of acute traumatic posterior sternoclavicular joint (SCJ) injuries are associated with a significant injury to the retrosternal structures. However, over the past 50 years there have only been a handful of such cases described in the literature. We have undertaken a CT arteriogram (CTA) within 48 hours on a series of patients that have sustained an acute posterior SCJ injury to assess the incidence of associated retrosternal vascular injuries. MATERIALS &
METHODS
Between May 2016 and December 2023 patients that had sustained an acute posterior SCJ injury and underwent a CT arteriogram within 24-hours of admission to hospital were reviewed. At the time of injury, the patients were specifically assessed for any associated clinical mediastinal or vascular symptoms. For the patients that underwent operative reduction and stabilisation the retrosternal vascular structures were visualised and assessed. Patient reported outcomes were assessed at final follow-up by the following scores: Quick-DASH, Rockwood SCJ, Constant and SANE score. Patients were also asked whether that had any specific retrosternal or vascular symptoms.
RESULTS
A total of 24 patients were available at final follow-up. Sixteen patients had a posterior SCJ dislocation and 8 had a posteriorly displaced Salter-Harris 2 fracture of the medial end of the clavicle. The mean age at the time of injury was 27.6 years (15-69) and the mean follow-up was 77.8 months (25 - 131). One patient had mediastinal symptoms in the form of dyspnoea at the time of injury. On CTA there was no evidence of a vascular injury, pseudoaneurysm or bleeding in any of the patients. Five patients had a haematoma associated with the capsular injury, 13 patients had evidence of compression of the left brachiocephalic vein and 1 patient had additional compression of the aortic arch. There was no evidence of any vascular injury on inspection in the 20 patients that underwent operative reduction and stabilisation. At final follow-up the mean Quick-DASH score was 2.0 (0 - 20.3), Rockwood SCJ Score was 14.5 (11 - 15), Modified Constant Score was 96.7 (69 - 100) and SANE score was 98.7 (80 - 100). None of the patients described any associated mediastinal or vascular problems.
CONCLUSION
Following an acute posterior SCJ injury, the incidence of retrosternal vascular injuries is less than had previously been considered. This should allow an adequate window of time for the management of this injury to be undertaken in an appropriate specialist unit.