[Anterior sternoclavicular dislocation, description of surgical technique]. / Luxación esternoclavicular anterior, descripción de técnica quirúrgica.

Sternoclavicular joint dislocation is an uncommon injury and is usually consequential to high-energy trauma. These can be classified as anterior or retro-sternal (posterior) dislocation. Sometimes they can be accompanied by injury to large vessels due to their anatomical proximity mainly retrosternal. Conceptually closed reduction is indicated as the first line of treatment in acute injuries and open reduction tends to be for failing the previous one. We present a case of anterior clavicular sternal dislocation, with recurrence after closed reduction under anesthesia and surgically operated with reconstruction and allograft use with favorable evolution six years after its surgical procedure.

La luxación esternoclavicular es una lesión poco frecuente y generalmente es consecuente a traumatismos de alto impacto. Éstas se pueden clasificar como luxaciones anteriores o retroesternales. En ocasiones pueden ser acompañadas de lesión a grandes vasos debido a su proximidad anatómica, principalmente las retroesternales. Conceptualmente la reducción cerrada está indicada como primera línea de tratamiento en fase aguda y la reducción abierta tiende a ser de segunda intención. Presentamos un caso de luxación esternoclavicular anterior, con recidiva posterior a reducción cerrada bajo anestesia e intervenido quirúrgicamente con reconstrucción y uso de aloinjerto con favorable evolución a seis años de su procedimiento quirúrgico.

Reconstrucción de la articulación esternoclavicular con aloinjerto: reporte de caso, descripción de la técnica y revisión de la literatura / Reconstruction of sternoclavicular dislocation with allograft. Case report, surgical technique and literature revision

La luxación de la articulación esternoclavicular (AEC) representa menos del 5% de las luxaciones de la cintura escapular. El tratamiento quirúrgico esta reservado para pacientes con inestabilidad de la articulación EC sintomática y persistente. Se han descrito varias técnicas diferentes para la reconstrucción AEC. El objetivo de nuestro trabajo fue reportar el caso de una paciente con inestabilidad EC anterior recurrente, a la que se le realizó una técnica de reconstrucción en forma de 8, como fue descripto por Spencer y Kuhn,utilizando un aloinjerto de tibial posterior

Sternoclavicular dislocations account for less than 5% of all dislocations of the scapular belt. Chronic instability without response to physical therapy warrants surgical treatment. Several techniques have been described for the reconstruction of the SC joint. The purpose of this work was to report on a case of a patient who developed chronic instability of the SC joint and underwent surgical reconstruction using the "figure of eight" technique as described by Spencer & Kuhn15 using posterior tibial allograft

Tibial shaft fracture and ankle injury - Case report / Fratura diafisária da tíbia e lesão do tornozelo - Relato de caso

ABSTRACT The authors report on a case of tibial shaft fracture associated with ankle injury. The clinical, radiological and surgical characteristics are discussed. Assessment of associated injuries is often overlooked and these injuries are hard to diagnose. When torque occurs in the lower limb, the ankle becomes susceptible to simultaneous injury. It is essential to make careful assessment based on clinical, radiographic, intraoperative and postoperative characteristics in order to attain functional recovery.

RESUMO Os autores relatam um caso de fratura diafisária de tíbia associado à lesão do tornozelo. As características clínicas, radiológicas e cirúrgicas são discutidas. A avaliação de lesões associadas são muitas vezes negligenciadas e de difícil diagnóstico. Quando um torque no membro inferior ocorre, o tornozelo fica suscetível a uma lesão simultânea. É essencial uma avaliação cuidadosa baseada no aspecto clínico, radiográfico, intra e pós-operatório para recuperação funcional.

Assessment of the function and resistance of sternoclavicular ligaments: A biomechanical study in cadavers.

BACKGROUND: Few biomechanical studies have assessed the resistance of the ligamentous structures of the sternoclavicular joint, and none have reproduced the physiological movements of the joint. Determining the structures that are injured in sternoclavicular dislocations is important for the surgical planning of acute or chronic ligament reconstruction. METHODS: Forty-eight joints from 24 human cadavers were studied, and they were divided into 4 groups of 12 joints each (retraction, protraction, depression and elevation). Biomechanical testing assessed primary and secondary failures. The mechanical resistance parameters between movements that occurred on the same plane (depression versus elevation, protraction versus retraction) were compared. RESULTS: The posterior sternoclavicular ligament was the most injured structure during the protraction test, but it was not injured during retraction. The anterior sternoclavicular ligament was the most affected structure during retraction and depression. The costoclavicular ligament was the most affected structure during elevation. Joint resistance was significantly greater during protraction movements when compared to retraction (P<0.05). CONCLUSION: The anterior sternoclavicular ligament was the most affected structure during retraction and depression movements. During protraction, lesions of the posterior sternoclavicular ligament were most frequent during elevation, and the costoclavicular ligament was the most frequently injured ligament. The resistance of the sternoclavicular joint was significantly greater during protraction movement when compared to retraction. LEVEL OF EVIDENCE: IV, basic science, biomechanics, cadaver model.

Medial epiphyseal fracture-detachment of the sternoclavicular joint with posterior displacement in a judo athlete - equivalent of posterior sternoclavicular dislocation

Posterior sternoclavicular dislocation is a rare traumatic injury that presents a potential risk of injury to mediastinal structures. The diagnosis is fundamentally clinical and treatment is done on an emergency basis. The authors report the clinical case of a young judo athlete with post-traumatic medial epiphyseal fracture-detachment, with posterior displacement (lesion equivalent to posterior sternoclavicular dislocation at pediatric ages). He underwent open reduction and ligament repair by means of a mini-anchor.The radiological and clinical outcome was excellent, and the athlete returned to his sports activity without limitations. We discuss the particular features of this pathological condition, along with the different therapeutic approaches and their complications.