Surgical management of sternoclavicular joint infections.
OBJECTIVE
Sternoclavicular joint infections are rare, and their management is controversial. We reviewed our experience with the surgical management of this condition.


METHODS
From August 1988 to August 2001, 26 patients (16 men and 10 women) were treated surgically for infected sternoclavicular joints. The median age was 56 years (range, 20-77 years). Patients who had a recent previous median sternotomy were excluded.


RESULTS
All patients were symptomatic. Pain was present in 21 patients, swelling in 14 patients, fever in 11 patients, and erythema in 9 patients. Associated conditions included recent or ongoing infections in other areas in 12 patients (pneumonia in 4 patients, multiple joint infections in 2 patients, and other in 6 patients) and an indwelling central venous catheter in 1 patient. Five patients had a history of trauma in the region of the joint. Four patients had prior joint incision and drainage. Unilateral sternoclavicular joint resection was done in 18 patients, bilateral resection in 2 patients, and incision and drainage with debridement in 6 patients. Wound culture results were positive in 24 patients, and the most common organism isolated was Staphylococcus aureus (n = 17). Eleven patients had transposition of the ipsilateral pectoralis major muscle to obliterate residual space and to reconstruct the chest wall. Two (7.7%) patients had complications, and 1 died (operative mortality, 3.8%). Follow-up was complete in all 25 operative survivors and ranged from 2 months to 10 years (median, 25 months). Twenty-one patients are alive without symptoms, infection, or limitations in range of motion. Four patients have died as a result of causes unrelated to their joint infections.


CONCLUSIONS
Symptomatic sternoclavicular joint infections often require surgical intervention. Surgical resection combined with muscle transposition provides effective long-term outcome.
Burkhart
Harold M
HM
Division of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minn 55905, USA.
Deschamps
Claude
C
Allen
Mark S
MS
Nichols
Francis C
FC
Miller
Daniel L
DL
Pairolero
Peter C
PC
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007239:Infections / Q000601:surgery*; D007592:Joint Diseases / Q000382:microbiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013247:Sternoclavicular Joint