gms | German Medical Science

Objectives: Traumatic sternoclavicular joint (SCJ) dislocations and medial clavicle fractures are rare; various surgical methods for restoration of the SCJ joint after the failure of conservative treatment or a prominent insult to the skin have been proposed, this is no ideal treatment strategy. The purpose of this study was to evaluate the clinical and radiographic outcomes of patients with SCJ dislocations or medial clavicle fractures who underwent open reduction and internal fixation using Balser plate technique.

Methods: A retrospective study of a consecutive cohort of 17 patients from April 2009 to September 2016 was performed for all patients undergoing open reduction and internal Balser plate fixation treatment for sternoclavicular dislocations or medial clavicle fractures. Clinical evaluation included the completion of a DASH (disability of the arm, shoulder, and hand) score questionnaire, Constant and Murley scale, the visual analog scale (VAS), and intraoperative and postoperative complications were recorded.

Results and conclusion: In the study, we enrolled 10 dislocations, 5 medial clavicle fracture and 2 fracture-dislocations, all patients were accomplished with acceptable reduction and rigid fixation by Balser plate fixation, with a mean follow-up of 20 months (range, 12-42 months), all cases had a good range of motion of the affected shoulder, and each fracture had solid clinical and radiographic evidence of fracture union at the final follow-up, and none of the cases were due to infection and recurrent instability. The mean shoulder forward flexion was 162.9° (range, 150-180°). The mean DASH score was 5.2 points (range, 0-18.3 points), and mean Constant and Murley joint function score was 93.7 points (range, 72-100 points), with 15 excellent cases and 2 good cases. And, all patients had significant reduction in pain, with a mean VAS score of 1.1 points (range, 2 to 7) at the final follow-up. Complications included on wound hematoma needed debridement and one revision reconstruction for recurrent instability resulted by hook migration. A Balser plate for SCJ dislocation or medial clavicle fractures is an easy and safe intervention with effective results, for it permitting early functional exercise while preserving the SCJ joint. However, this treatment calls for a well-trained surgeon to avoid damage to retrosternal structures.