RESUMO
CASE: We present a 17-year-old male patient with an initially missed posterior sternoclavicular fracture dislocation who presented with symptoms related to thrombotic emboli arising from a pseudoaneurysm. He was treated 6 weeks after injury with a figure-of-eight tendon allograft repair with good clinical outcomes. CONCLUSION: This is a unique presentation that highlights the significant risk of a missed diagnosis, life-threatening complications that may ensue, and biomechanically superior surgical intervention.
Assuntos
Falso Aneurisma , Humanos , Masculino , Adolescente , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Falso Aneurisma/etiologia , Articulação Esternoclavicular/lesões , Articulação Esternoclavicular/diagnóstico por imagem , Articulação Esternoclavicular/cirurgia , Clavícula/lesões , Clavícula/cirurgia , Clavícula/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Fraturas Ósseas/complicações , Fraturas Ósseas/diagnóstico por imagem , Luxações Articulares/cirurgia , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/complicações , Fratura-Luxação/diagnóstico por imagem , Fratura-Luxação/cirurgia , Fratura-Luxação/complicaçõesRESUMO
Fractures and dislocations of the sternoclavicular joint (SCJ) are uncommon, accounting for <5% of all shoulder girdle injuries. They are relatively more common in the pediatric population than in the adult population and can often present concurrently as a posteriorly displaced medial clavicular dislocation with a fracture through the unfused physis. It is especially important to recognize this injury, because its management and potential sequelae are very different from those for fractures of the clavicle shaft. This type of injury frequently requires closed or open operative management because fracture-dislocation of the SCJ can be associated with potentially serious complications such as pneumothorax, brachial plexus injury, vagus nerve injury, tracheal injury, and vascular compromise. Few case reports describe fracture-dislocation of the SCJ resulting in vascular injuries. We describe the case of a 17-year-old boy who sustained a blunt hockey injury resulting in a right physeal fracture-dislocation of the SCJ causing an innominate artery pseudoaneurysm. This was treated with excision of the pseudoaneurysm, bovine pericardial patch angioplasty repair of the innominate artery, and open reduction and internal fixation of the medial clavicular physeal fracture.