65 - Preissitzung
16. Mai 2019, 13:45 - 15:15, Sopra 3, 4. OG
Epiphysiolysis (Type Salter-Harris I) of the medial clavicle with retrosternal displacement – A case report
B. Brinken, C. Sommer, Presenter: B. Brinken (Chur)
Trauma of the sternoclavicular joint is rare and reported with less than 5 % of all shoulder girdle lesions. Due to the late ossification and growth plate fusion of the medial end of the clavicle, epiphysiolysis is the most common injury among immature patients. The more uncommon posterior dislocation can lead to serious complications because of the anatomical proximity to neurovascular and mediastinal structures.
We report the case of a 13 year old girl who presented after a fall from a trampoline. As clinically suspected, a MRI showed a dorsally dislocated medial clavicle with surrounding hematoma but without additional injuries or compression of the mediastinal structures. We decided to perform immediate surgical treatment. Anteriorly an intact periosteum was found and incised longitudinal to the capsule. The medial metaphysis of the clavicle was displaced dorsally and stuck behind the manubrium with the medial epiphysis remaining in the right position, the suspected diagnosis of an epiphysiolysis type Salter Harris I was confirmed. Reduction was achieved using a pointed reduction forceps on the displaced clavicle, but gross instability remained when moving the shoulder. Through the minimally incised anterior capsule two interfragmentary resorbable pins were placed, inserted from the cartilage site of the medial epiphysis of the clavicle. With this fixation enough stabilisation was achieved even when moving the shoulder. An additional tension band wiring between the sternal manubrium and medial clavicle using a slowly resorbable monofile suture in a figure-of-eight fashion was applied. Finally the periosteum and capsule were sutured. Postoperatively early motion supported by physiotherapists was allowed without loading the injured arm for four weeks. During night the arm was immobilised in a shoulder gilet.
Clinically the patient regained complete function without any pain 6 weeks postoperatively and the X-rays showed a symmetrical shoulder girdle.
Restoration of anatomical position in this injury is inevitable. In this case the reduction alone did not provide enough stability and needed additional fixation. This was successfully achieved with two absorbable pins inserted from the articular part antegrade in the clavicle leading to an excellent result. This technique might be considered in patients with epiphysiolysis, where extra stability is required.