[Manubriosternal dislocation caused by indirect flexion-compression trauma. A case report and review of the literature].
Manubriosternal dislocation caused by indirect flexion-compression trauma is an extremely rare condition. Two forms of manubriosternal luxation are distinguished: in type I the sternum is dislocated posterior and in type II anterior to the manubrium. Direct or indirect trauma may cause manubriosternal dislocation. Mode of injury in direct trauma is mostly a head-on collition in a motor accident resulting either in type I or type II luxation. The unusual origin of manubriosternal dislocation by indirect trauma is put down to flexion-compression injuries of the thoracic spine and results in a type II dislocation. Predisposition to manubriosternal dislocation by indirect trauma consists in rheumatoid arthritis or extreme forms of kyphosis. Outcome of many patients treated conservatively after initial reposition with adhesive tape, symptomatic pain therapy, cryotherapy and prohibition of any physical training over several weeks is subluxation or complete luxation of the manubriosternal joint. This condition may lead to chronic pain, periarticular calcification with ankylosis and progredient deformation. Lacking a controlled study for treatment of manubriosternal dislocation a standard therapeutic regime could not be established yet. In the literature only a few case-reports of patients undergoing operative therapy are published. We report a type II dislocation of the manubriosternal joint caused by indirect flexion-compression trauma. We achieved a very good long-term result using a 8-hole 1/3 tubular plate for fixation of the manubriosternal joint after reposition.
Berufsgenossenschaftliche Kliniken Bergmannsheil, Chirurgische Klinik und Poliklinik, Bürkle-de-la-Camp-Platz 1, 44789 Bochum. tkaelicke@compuserve.de
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Kälicke
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Feil
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Steuer
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Hansis
D000328:Adult; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000209:etiology / Q000601:surgery; D008297:Male; D008371:Manubrium / Q000000981:diagnostic imaging; D009984:Orthopedic Fixation Devices; D013902:Radiography, Thoracic; D012307:Risk Factors; D013249:Sternum / Q000000981:diagnostic imaging; D013997:Time Factors