PMC4900050_01
18-year-old male with posterior dislocation of the SCJ. X-ray of bilateral SC joints. There is asymmetric alignment of the SCJs with superior displacement of the right clavicle, superimposed on the third costovertebral joint.
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The patient's arm was placed in a sling, and an emergent CT scan was obtained after x-rays revealed an asymmetry of the SC joints (Fig. 1). The patient's arm was placed in a sling, and an emergent CT scan was then obtained (Figure 2, Figure 3).
18-year-old male with posterior dislocation of the SCJ. Axial CT scan of posterior fracture dislocation of right SC joint, demonstrating relative posterior displacement of the right clavicle. There is a small bony fragment (the ossifying epiphysis) on the anterior aspect of the distal right clavicle (arrow). The vessels are not fully evaluated due to lack of intravascular contrast; however, the medial clavicle is immediately anterior to the SVC. There is no large hematoma or pneumomediastinum.
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The patient's arm was placed in a sling, and an emergent CT scan was obtained after x-rays revealed an asymmetry of the SC joints (Fig. 1). The patient's arm was placed in a sling, and an emergent CT scan was then obtained (Figure 2, Figure 3).
18-year-old male with posterior dislocation of the SCJ. 3D CT scan of posterior fracture-dislocation of right SC joint. A) Oblique view shows a small fracture fragment (arrow) on the anterior aspect of the clavicular head. B) Axial view viewed from below shows relative posterior displacement of the entire right clavicle shaft relative to the sternum.
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The patient's arm was placed in a sling, and an emergent CT scan was obtained after x-rays revealed an asymmetry of the SC joints (Fig. 1). The patient's arm was placed in a sling, and an emergent CT scan was then obtained (Figure 2, Figure 3).
18-year-old male with posterior dislocation of the SCJ. Intra-operative photo showing the physeal fracture, identified by the suction tip (left) and the SC joint, identified by the Freer elevator (picture right). The tissue between the two includes the medial clavicular epiphysis and the meniscus.
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The epiphysis was noted to be still attached to the articular disk and in appropriate orientation with the manubrium; however, the medial clavicle had dislocated posteriorly through the physis (Figure 4, Figure 5).
18-year-old male with posterior dislocation of the SCJ. Intra-operative photo showing the displaced fracture before reduction. The displaced clavicular shaft is held by a reduction forceps.
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The epiphysis was noted to be still attached to the articular disk and in appropriate orientation with the manubrium; however, the medial clavicle had dislocated posteriorly through the physis (Figure 4, Figure 5).
18-year-old male with posterior dislocation of the SCJ. Intra-operative photo showing the reduction, which required distraction and 90 degrees of clockwise rotation.
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The medial clavicle was then sewn back to the epiphysis with transosseous and transepiphyseal #2 FiberWire sutures (Arthrex, Naples, FL), with excellent stability achieved to the repair (Figure 6, Figure 7).
18-year-old male with posterior dislocation of the SCJ. Intra-operative photo showing fracture stabilization, with heavy Fiberwire suture passed through the bone via drill holes.
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The medial clavicle was then sewn back to the epiphysis with transosseous and transepiphyseal #2 FiberWire sutures (Arthrex, Naples, FL), with excellent stability achieved to the repair (Figure 6, Figure 7).
18-year-old male with posterior dislocation of the SCJ. Postoperative axial CT scan showing reduction of the right SCJ. The epiphysis is in near-anatomic alignment with the medial metaphysis of the clavicle.
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A postoperative CT scan demonstrated near-anatomic reduction of the SCJ fracture-dislocation (Figure 8, Figure 9).
18-year-old male with posterior dislocation of the SCJ. Postoperative 3D CT scan following reduction. A) View from above and B) view from below show slight residual posterior translation of the right medial clavicle compared to the left side.
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A postoperative CT scan demonstrated near-anatomic reduction of the SCJ fracture-dislocation (Figure 8, Figure 9).