title: Parallel plating for a sternomanubrial dislocation.
abstract: Sternomanubrial dislocations are rare injuries. Although few cases of this injury have been reported in the literature, the etiology has varied widely: trampoline injury, seizures, falls from height, sporting injuries, gradual deformities from spine fractures, and motor vehicle collisions. This injury has been classified into 2 types: in type I, the sternal body is displaced posteriorly to the manubrium, and in the more common type II, the sternal body is displaced anteriorly. The sternomanubrial joint is an amphiarthroidal joint that bears hyaline cartilage on both surfaces connected by a fibrocartilage meniscus. It serves a protective role to vital thoracic structures and is an anterior stabilizing strut to the thorax, assisting the thoracic spine in upright stability. It is important to not ignore type I dislocations because posterior sternum displacement is a harbinger of injury to the pulmonary tree, heart, and esophagus. Chronic instability at this joint can lead to dyspnea and dysphasia due to sternum displacement. In the right scenario, type II injuries are occasionally treated conservatively with palliative treatment until the sternum heals with malformation. This article describes the case of a 20-year-old man who was treated surgically for symptomatic type II sternomanubrial dislocation with dual anterior locked plating. Locked plating gives the benefit of unicortical fixation, with the screws and plate acting as a unit to resist motion. Screw pullout and failure is less common, and the construct is more resistant for this application. The patient returned to full participation in activities of daily living and military duty 4 months postoperatively.
authors.affiliation: Orthopaedic Trauma Service, United States Navy, Naval Medical Center Portsmouth, VA, USA. orthogaines@hotmail.com
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gaines
authors.forename: Addison
authors.initials: A
authors.lastname: Wilson
authors.forename: Jared
authors.initials: J
authors.lastname: Antevil
authors.forename: Marlene
authors.initials: M
authors.lastname: Demaio
mesh_terms: D001860:Bone Plates; D001863:Bone Screws; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D008297:Male; D008371:Manubrium / Q000293:injuries*; D013249:Sternum / Q000293:injuries*; D055815:Young Adult