Letter to the Editor
Tracheal Compression Secondary to Posterior Sternoclavicular Dislocation
Compresión traqueal secundaria a una luxación esternoclavicular posterior
Pedro M. Rodríguez Suárez
, Mohamed Hussein Serhal, Jorge L. Freixinet Gilart
Corresponding author
Servicio de Cirugía Torácica, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
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Rodríguez Suárez, Mohamed Hussein Serhal, Jorge L. Freixinet Gilart" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Pedro M." "apellidos" => "Rodríguez Suárez" "email" => array:1 [ 0 => "prosu2001@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Mohamed" "apellidos" => "Hussein Serhal" ] 2 => array:2 [ "nombre" => "Jorge L." "apellidos" => "Freixinet Gilart" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía Torácica, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding Author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Compresión traqueal secundaria a una luxación esternoclavicular posterior" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 542 "Ancho" => 1301 "Tamanyo" => 95229 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial and sagittal computed tomography slice showing posterior displacement of the clavicular head with tracheal compression.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Posterior sternoclavicular dislocation (PSCD) is uncommon but may cause severe mediastinal injury. We report the case of a patient with PSCD and symptomatic tracheal compression requiring surgical intervention. This was a 16-year-old male with direct chest injury presenting with pain in the right shoulder and cough forty-eight hours after the event. On physical examination, deformity of the sternoclavicular joint and limited abduction (90°) was observed. The chest X-ray showed posterior sternoclavicular dislocation. Closed reduction was performed and the joint was immobilized with a sling. Fifteen days later, cough, stridor and breathing difficulties persisted. Computed tomography (CT) confirmed right PSCD with severe tracheal compression (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Surgery consisted of reduction and stabilization with cerclage wiring. The respiratory symptoms resolved.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Dislocation of the sternoclavicular joint is rare (<1%) due to the strength of the ligaments. It occurs in young people under the age of 25, the most common cause being traffic accidents (40%). A total of 95% are anterior, since the posterior ligaments are thicker and stronger than the anterior ones.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> PSCD is caused by anterior trauma to the clavicle (direct mechanism) or posterolateral trauma to the shoulder (indirect mechanism).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Up to 30% of PSCD affect mediastinal structures such as the brachial plexus, brachiocephalic vein, innominate artery, trachea, bronchi and esophagus.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Diagnosis is based on history, physical examination and radiology.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Physical examination reveals loss of joint congruency, sternoclavicular depression, pain and functional impotence. Other symptoms are derived from the affected mediastinal structures: venous congestion, dysphagia, cough, dyspnea and stridor.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Chest X-ray should be the initial examination undertaken (dislocation, costoclavicular fracture, pneumothorax, pneumomediastinum).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Echography has been shown to be useful, but is not commonly used. CT is the test of choice for confirming PSCD and for excluding mediastinal complications.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> Magnetic resonance imaging can be performed in patients who are allergic to contrast media. Fiberoptic bronchoscopy is not essential for diagnosis. Treatment varies depending on the time since the event and associated injuries. Orthopedic intervention, consisting of closed reduction, is applied in PSCD within 48<span class="elsevierStyleHsp" style=""></span>h of the event in the absence of mediastinal complications. However, this procedure fails in up to 50% of cases, with recurrence or unstable anterior subluxation.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Surgical treatment consists of reduction and stabilization, and is indicated if more than 48<span class="elsevierStyleHsp" style=""></span>h have elapsed after the injury, if closed reduction fails, if the joint is unstable, or if there is recurrence of the PSCD and mediastinal injury. Numerous stabilization techniques have been described, including fixation with nails or wire, joint reconstruction with subclavian tendon, sternocleidomastoid muscle and fascia lata (tenodesis), costoclavicular-clavicosternal cerclage and resection of the medial third of the clavicle.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Late diagnosis and lack of treatment are often associated with complications such as arthritis, tracheoesophageal fistula or thoracic outlet syndrome.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> PSCD involving injury of the trachea is very uncommon. It should be suspected in patients with clavicle or shoulder injury who present respiratory symptoms. Diagnosis is based on CT and the treatment of choice is surgical reduction and stabilization.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodríguez Suárez PM, Hussein Serhal M, Freixinet Gilart JL. Compresión traqueal secundaria a una luxación esternoclavicular posterior. Arch Bronconeumol. 2014;50:306–307.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 542 "Ancho" => 1301 "Tamanyo" => 95229 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial and sagittal computed tomography slice showing posterior displacement of the clavicular head with tracheal compression.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bronchoalveolar lavage in malignancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V. 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Rossouw" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2013" "volumen" => "95" "paginaInicial" => "5" "paginaFinal" => "55" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005000000007/v1_201406290026/S1579212914001463/v1_201406290026/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005000000007/v1_201406290026/S1579212914001463/v1_201406290026/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914001463?idApp=UINPBA00003Z" ]
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| 2017 January | 34 | 7 | 41 |
| 2016 December | 39 | 9 | 48 |
| 2016 November | 48 | 9 | 57 |
| 2016 October | 52 | 13 | 65 |
| 2016 September | 151 | 9 | 160 |
| 2016 August | 73 | 11 | 84 |
| 2016 July | 44 | 18 | 62 |
| 2016 March | 3 | 0 | 3 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 54 | 3 | 57 |
| 2015 September | 58 | 13 | 71 |
| 2015 August | 52 | 14 | 66 |
| 2015 July | 54 | 9 | 63 |
| 2015 June | 47 | 11 | 58 |
| 2015 May | 48 | 13 | 61 |
| 2015 April | 30 | 7 | 37 |
| 2015 March | 31 | 7 | 38 |
| 2015 February | 34 | 7 | 41 |
| 2015 January | 49 | 3 | 52 |
| 2014 December | 24 | 10 | 34 |
| 2014 November | 33 | 11 | 44 |
| 2014 October | 41 | 12 | 53 |
| 2014 September | 1 | 1 | 2 |
| 2014 August | 0 | 2 | 2 |
| 2014 July | 1 | 0 | 1 |
Show all
