title: Sternoclavicular joint surgery: how far does danger lurk below?
abstract: BACKGROUND
  Surgical stabilization of the sternoclavicular joint (SCJ) is infrequent, and cardiothoracic surgery assistance is often recommended. Patient safety and surgeon efficiency may be improved by greater understanding of the anatomic relationships near the SCJ. The purpose of this study is to determine the distances from the SCJ to critical structures in the superior mediastinum.
  
  
  METHODS
  Distances from the posterior SCJ to adjacent mediastinal structures were recorded using contrast computed tomography scans of 49 consecutive patients. Patient sex, height, body mass index, side, age, and thickness of the sternum and medial clavicle were also recorded.
  
  
  RESULTS
  The mean distance to the nearest anatomic structure deep to the clavicular region of the SCJ was 6.6 mm and was 12.5 mm for the sternal region. The clavicle was an average thickness of 18 mm, and the sternum was an average thickness of 17 mm. The closest structure was the brachiocephalic vein. An artery was identified as the closest structure in 21.2% of patients. Distance differences between the right and left sides were noted, but sex had no bearing on distance to structures.
  
  
  CONCLUSIONS
  Multiple mediastinal structures are close to the SCJ. The most frequent structure at risk of injury deep to the SCJ is the brachiocephalic vein. Such knowledge may improve patient safety.
authors: Department of Surgery, Division of Orthopaedics, University of Alabama at Birmingham, Birmingham, AL 35294, USA. brent.ponce@ortho.uab.edu
authors: Brent A
authors: BA
authors: Ponce
authors: Joseph A
authors: JA
authors: Kundukulam
authors: Ryan
authors: R
authors: Pflugner
authors: Gerald
authors: G
authors: McGwin
authors: Richard
authors: R
authors: Meyer
authors: William
authors: W
authors: Carroll
authors: Douglas J
authors: DJ
authors: Minnich
authors: Matthew C
authors: MC
authors: Larrison
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016121:Brachiocephalic Veins / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D015331:Cohort Studies; D003287:Contrast Media; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008482:Mediastinum / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods; D061214:Patient Safety; D018570:Risk Assessment; D013247:Sternoclavicular Joint / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003287:Contrast Media