All 16 cases of SCJ dislocation or fracture treated between October 2016 and December 2020 were included in the study. Informed written consent for publication of this report and accompanying figures was obtained from the patients. The hospital research ethics committee approved the study. Selection criteria included (1) dislocations that could not be reduced by nonoperative treatment and type D fresh proximal clavicle fractures according to the Throckmorton classification (Fig 1.); (2) dislocations that were prone to recurrence during shoulder movement and cases with prominent skin lesions; and (3) patients without underlying diseases such as heart disease. Exclusion criteria. (1) Patients with brain injury or severe underlying chronic disease and, therefore, cannot tolerate the risk of surgery and anesthesia; (2) pathological fractures; (3) open fractures; (4) combined vascular or neurological injuries. (5) The patient requested conservative treatment, even though closed reduction was pointless.all procedures were performed by the senior author after obtaining informed consent from all patients.
Conventional radiographs are not sensitive for posterior sternoclavicular dislocations, and computed tomography (CT) represents the imaging modality of choice[15, 16]. All patients underwent the standard preoperative assessment, including preoperative history, physical examination, plain radiograph of the clavicle, sternum and thorax completed with serendipity view and a CT scan of the thorax(Fig.2).
All patients were positioned supine with free draping of the ipsilateral arm on the operating table, and underwent general anesthesia.An hockey-stick shaped incision of approximately 8-10 cm length was made from the medial clavicle,via the sternoclavicular joint,and to the superior part of the sternal manubrium.Subcutaneous superficial fascia and deep fascia were incisionally incisional to expose the manureum sternum, sternoclavicular joint and proximal clavicular fracture, showing obvious fracture displacement.After the upper margin was exfoliated, the posterior sternal soft tissue was exfoliated along the posterior margin of the manubrium sternum with periosteum exfoliator.From above the sternal handle place(the diamond drill jig sternum has along the thread in the block at the back of the handle), in the centerline of the sternal handle drilling, drilling through the steel wire head end lock on the jig block slice, pull out of jig, steel wire, jig, the steel wire head end locked into the appropriate sternoclavicular hook plate, locked sternoclavicular hook plate through the sternocleidomastoid trailing edge.The sternum end of the sternum plate of the sternum was pierced through the hole through the traction of the wire wire(Fig.1). The proximal clavicle fracture was reduced. After satisfactory reduction, the plate was fixed on the clavicle with a common screw (for proximal clavicular fracture comminuted, it is recommended to use an Achilles tendon suture to strengthen the fixation), and a gasket and nut were installed on the hook thread of the patient.A large amount of normal saline w-as rinsed in the surgical area. After the instrument and auxiliary materials were checked correctly, a negative pressure drainage tube was placed in the surgical area, the skin was sutured layer by layer, and the incision was covered with sterile dressing.
Three days after surgery, patients were allowed to do passive forward flexion and abduction of the shoulder joint under the guidance of the physical therapist. Depending on the degree of pain and postoperative X-ray and CT scan images, the range of motion could be gradually increased, and no weight-bearing exercise was allowed. Weight-bearing exercises were gradually started after 6 weeks postoperatively. Postoperative follow-up is every 4 weeks until the bone heals, and every 3 months after the bone heals, and exercise should be avoided for 12 weeks after surgery. The sternoclavicular plate can be removed at 12 months after surgery according to the clinical course (Fig 3).
Postoperative function was evaluated using American Shoulder and Elbow Surgeons’ Form(ASES).The system is a 100-point system consisting of the patient's own assessment section (50%) and the cumulative daily activities section (50%).Patients were assessed for pain, stability, and daily activities.Part of the doctor's assessment is mobility, signs, strength tests, and stability.The higher the score, the better shoulder function.VAS was used to evaluate the pain scale. The life function scale included 10 daily activities: dressing, combing hair, and going to the toilet.Placzek et al. found that ASES score had low correlation with age and high credibility through studies.Patients were routinely followed at 2 weeks and 9–12 months postoperatively. No significant complications occurred during follow-up(Fig.4).
All statistical data were statistically analyzed using the statistical software SPSS 20.0 (Statistical Package for Social Sciences, SPSS Inc, Chicago, IL, USA) to calculate the results of each measure, and the values are expressed as mean ± standard deviation. Count data were analyzed by t-test, and P < 0.05 was set as a statistically significant difference.