The incidence of retrosternal vascular injuries following acute traumatic posterior sternoclavicular joint injuries is less than had previously been considered

It has previously been considered that approximately 30% of acute traumatic posterior sternoclavicular joint (SCJ) injuries are associated with a significant injury to the retrosternal structures. However, over the past 50 years there have only been a handful of such cases described in the literature. We have undertaken a computed tomography (CT) arteriogram within 48 hours on a series of patients who have sustained an acute posterior SCJ injury to assess the incidence of associated retrosternal vascular injuries. Between May 2016 and December 2023, patients who had sustained an acute posterior SCJ injury and underwent a CT arteriogram within 24 hours of admission to hospital were reviewed. At the time of injury, the patients were specifically assessed for any associated clinical mediastinal or vascular symptoms. For the patients who underwent operative reduction and stabilization, the retrosternal vascular structures were visualized and assessed. Patient-reported outcomes were assessed at final follow-up by the following scores: short version of the Disabilities of the Arm, Shoulder and Hand (Quick-DASH), Rockwood SCJ Score, Constant score, and the Single Assessment Numeric Evaluation (SANE). Patients were also asked whether they had any specific retrosternal or vascular symptoms. A total of 24 patients were available at final follow-up. Sixteen patients had a posterior SCJ dislocation, and 8 had a posteriorly displaced Salter-Harris II fracture of the medial end of the clavicle. The mean age at the time of injury was 27.6 years (15-69), and the mean follow-up was 77.8 months (25-131). One patient had mediastinal symptoms in the form of dyspnea at the time of injury. On CT arteriogram, there was no evidence of a vascular injury, pseudoaneurysm, or bleeding in any of the patients. Five patients had a hematoma associated with the capsular injury, 13 patients had evidence of compression of the left brachiocephalic vein, and 1 patient had additional compression of the aortic arch. There was no evidence of any vascular injury on inspection in the 20 patients who underwent operative reduction and stabilization. At final follow-up, the mean Quick-DASH score was 2.0 (0-20.3), Rockwood SCJ Score was 14.5 (11-15), Modified Constant Score was 96.7 (69-100), and SANE score was 98.7 (80-100). None of the patients described any associated mediastinal or vascular problems. Following an acute posterior SCJ injury, the incidence of retrosternal vascular injuries is less than had previously been considered. This should allow an adequate window of time for the management of this injury to be undertaken in an appropriate specialist unit.