title: Current presentation and optimal surgical management of sternoclavicular joint infections.
abstract: BACKGROUND
  Infection of the stemoclavicular joint is unusual, and treatment of this entity has not been standardized. We sought to characterize the current presentation and optimal management of this disease.
  
  
  METHODS
  We retrospectively reviewed the records of the last 7 patients undergoing operation for suppurative infections of the stemoclavicular joint at this institution. Patients were interviewed regarding upper extremity function after formal joint resection.
  
  
  RESULTS
  Predisposing factors were common and included diabetes mellitus (n = 2), clavicular fracture (n = 1), human immunodeficiency virus infection (n = 1), immunosuppression (n = 1), and pustular skin disease (n = 1). All patients presented with local symptoms including clavicular mass and tenderness. Diagnosis and evaluation were facilitated by cross-sectional imaging. Organisms isolated included Staphylococcus aureus, group G streptococcus, and Proteus and Propionibacterium species. Antibiotic therapy and simple drainage and debridement were generally ineffective, leading to recurrence of infection in 5 of 6 patients treated initially in this manner. Six patients were treated with resection of the stemoclavicular joint and involved portions of first or second ribs with soft tissue coverage by advancement flap from the ipsilateral pectoralis major muscle. Response to this therapy was excellent, with cure in all patients, no wound complications, and excellent upper extremity function at long-term follow-up.
  
  
  CONCLUSIONS
  Aggressive surgical management including resection of the sternoclavicular joint and involved ribs with pectoralis flap closure would appear to be the preferred treatment for all but the most minor infections of the sternoclavicular joint. This approach has minimal impact on upper extremity function.
authors.affiliation: Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
authors.forename: Howard K
authors.initials: HK
authors.lastname: Song
authors.forename: T Sloane
authors.initials: TS
authors.lastname: Guy
authors.forename: Larry R
authors.initials: LR
authors.lastname: Kaiser
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Shrager
mesh_terms: D000328:Adult; D000368:Aged; D001170:Arthritis, Infectious / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001424:Bacterial Infections / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012272:Ribs / Q000000981:diagnostic imaging / Q000601:surgery; D012307:Risk Factors; D013247:Sternoclavicular Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed