CASE REPORT   

Medicina dello Sport 2019 September;72(3):468-73

DOI: 10.23736/S0025-7826.19.03466-5

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English, Italian

A rare case of posterior sternoclavicular joint dislocation in a motorcycle rider

Selman YENİOCAK ¹ ✉, Adem AZ ¹, Muhammed F. ÖZDEN ¹, Ahmet DEMİREL ², Tarık AKDEMİR ¹, Özlem UZUN ³

¹ Department of Emergency Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey; ² Department of Emergency Medicine, University of Health Sciences, Okmeydanı Training and Research Hospital, Istanbul, Turkey; ³ Department of Emergency Medicine, University of Health Sciences, Bağcılar Training and Research Hospital, Istanbul, Turkey

Sternoclavicular joint dislocations (SCJDs) are the least encountered large joint dislocations and are generally caused by high-energy blunt trauma, such as motor vehicle accidents, sports injuries, or falls from heights. This report discusses posterior SCJD (PSCJD), a very rare case, presenting to the emergency department following a motorcycle accident in the light of the current literature. A 20-year-old man presented to the Emergency Department with pain and swelling in the neck resulting from a fall from a motorcycle one day previously. Forward deviation was present in the left shoulder, and he held the upper extremity in flexion, supporting the left elbow with the other hand, while his head was deviated to the left. Physical examination revealed restricted movement in the neck and left arm, and deformity in the region of the left sternoclavicular joint (SCJ). Lung X-ray revealed a difference in the levels of the bilateral SCJs. Computerized tomography (CT) of the neck and thorax revealed PSCJD without accompanying injury. Closed reduction with sedation was attempted in the emergency department, but this was unsuccessful, and the patient was interned for open reduction. PSCJDs may be accompanied by fatal additional injuries. Dislocation may not be visible with standard radiographic imaging. Emergency department physicians should suspect PSCJD on the basis of history and careful physical examination findings and need to perform with-contrast CT scans. Closed reduction may be attempted with appropriate sedation in the emergency department in the case of PSCJDs without accompanying injuries.

KEY WORDS: Joint dislocations; Sternoclavicular joint; Accidents; Wound and injuries; Hospital emergency service