Surgical management of sternoclavicular joint infections.

Abstract

OBJECTIVE:

Sternoclavicular joint infections are rare, and their management is controversial. We reviewed our experience with the surgical management of this condition.

METHODS:

From August 1988 to August 2001, 26 patients (16 men and 10 women) were treated surgically for infected sternoclavicular joints. The median age was 56 years (range, 20-77 years). Patients who had a recent previous median sternotomy were excluded.

RESULTS:

All patients were symptomatic. Pain was present in 21 patients, swelling in 14 patients, fever in 11 patients, and erythema in 9 patients. Associated conditions included recent or ongoing infections in other areas in 12 patients (pneumonia in 4 patients, multiple joint infections in 2 patients, and other in 6 patients) and an indwelling central venous catheter in 1 patient. Five patients had a history of trauma in the region of the joint. Four patients had prior joint incision and drainage. Unilateral sternoclavicular joint resection was done in 18 patients, bilateral resection in 2 patients, and incision and drainage with debridement in 6 patients. Wound culture results were positive in 24 patients, and the most common organism isolated was Staphylococcus aureus (n = 17). Eleven patients had transposition of the ipsilateral pectoralis major muscle to obliterate residual space and to reconstruct the chest wall. Two (7.7%) patients had complications, and 1 died (operative mortality, 3.8%). Follow-up was complete in all 25 operative survivors and ranged from 2 months to 10 years (median, 25 months). Twenty-one patients are alive without symptoms, infection, or limitations in range of motion. Four patients have died as a result of causes unrelated to their joint infections.

CONCLUSIONS:

Symptomatic sternoclavicular joint infections often require surgical intervention. Surgical resection combined with muscle transposition provides effective long-term outcome.

• Authors: Harold M Burkhart, Claude Deschamps, Mark S Allen, Francis C Nichols 3rd, Daniel L Miller, Peter C Pairolero
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 125 Issue 4 Pg. 945-9 (Apr 2003) ISSN: 0022-5223 [Print] United States
• PMID: 12698160 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Female
• Follow-Up Studies
• Humans
• Infections (surgery)
• Joint Diseases (microbiology, surgery)
• Male
• Middle Aged
• Sternoclavicular Joint