Rare But Dangerous Collar Bone Dislocation

Although uncommon, posterior sternoclavicular joint (SCJ) dislocations are possible. A blow to the middle of the clavicle (collar bone) forces the bone inward. Dislocation occurs at the point where the clavicle attaches to the breast bone (sternum). The most common causes of this injury are car accidents (striking the steering wheel) and sports injuries. Less often, a shoulder injury is the indirect cause of a dislocated SCJ.

In this article, three orthopedic surgeons from the Medical University of Ohio review this rare injury. The location of the esophagus, heart, lungs, and major blood vessels behind the sternum make this injury critical. The broken bone can pierce any of these structures. Because it can be fatal, successful management is important.

The authors suggest knowing the anatomy of the SCJ is essential. A brief anatomy review of the SCJ, surrounding soft tissues, and structures underneath is presented. Signs and symptoms of compression of the various anatomical structures are also presented. Special imaging techniques with X-rays, CT scans, and ultrasound are given.

The dislocation should be reduced (the joint is put back in place or relocated) in the first 48 hours. Three methods for closed (nonoperative) reduction are described. If it's can't be reduced without surgery, then advice and precautions are given for operative treatment.

For example wires, screws, and pins must be used with extreme caution (if at all). They can come loose and move or migrate to the heart, aorta, or lung. Other ways to avoid complications from this injury are also discussed.

Reference: 

Nicholas Gove, MD, et al. Posterior Sternoclavicular Dislocations: A Review of Management and Complications. In The American Journal of Orthopedics. March 2006. Vol. 35. No. 3. Pp. 132-136.

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