Medial clavicle resection for acute traumatic posterior sternoclavicular dislocation: Experience from Grenoble Alpes University Hospital.

Abstract

Posterior sternoclavicular dislocations (PSCDs) are rare but potentially life-threatening injuries. Beyond the acute management of mediastinal complications, restoring optimal shoulder function remains the primary goal of treatment. Although the optimal surgical strategy remains controversial, our institutional protocol consists of systematic medial clavicle resection performed during emergency surgery, with the aim of reducing the risk of residual sternoclavicular instability. The aim of this study was to evaluate the functional outcomes and complications of systematic medial clavicle resection performed as an emergency procedure for acute traumatic PSCDs. A retrospective single-centre study was conducted at Grenoble Alpes University Hospital (2019-2026). All consecutive patients who underwent medial clavicle resection for acute traumatic PSCDs were included. The primary outcome was the QuickDASH score at 12 months. Secondary outcomes included the QuickDASH score at 1-month, postoperative complications according to the Clavien-Dindo classification, and return-to-work and return-to-sport outcomes. Twenty-five patients (23 males, 2 females; mean age 29 years) were included. Sports injuries accounted for 84% of cases. The median time from injury to surgery was 2 days [IQR, 1-6]. The median operative time was 33 min [IQR, 24-45]. No intraoperative complications occurred. The overall complication rate was 12% (n = 3), consisting of superficial wound infections. No vascular complications, pneumothorax, or deaths were observed. The median QuickDASH score at 12 months was 4.55 points [IQR, 2.29-13.64]. At 12 months, 75% of patients achieved a QuickDASH score ≤ 10. The return-to-work rate was 100% and the return-to-sport rate was 100%. Systematic medial clavicle resection performed as an emergency procedure for acute traumatic PSCDs yields excellent functional outcomes with low complication rate. This approach, performed by thoracic surgeons, provides a definitive solution to posterior instability while minimising risks to mediastinal structures.