title: Surgical Management of Sternoclavicular Joint Infections.
abstract: BACKGROUND
  Infections of the sternoclavicular joint (SCJ) respond poorly to nonoperative management and typically require resection. We examined presenting characteristics and outcomes after surgical management of SCJ infections, reviewing a 20-year single-institution experience.
  
  
  METHODS
  From January 1992 to December 2012, 40 patients (age, 57 ± 12 years; 70% male) underwent resection of an infected SCJ. Sternal infections after cardiac surgery were excluded. Clinical features, microbiology, recurrence, survival, and functional impairment were assessed. Infection was documented by the surgeon, and supported by tissue culture. Clinical presentation and treatment course were obtained by review of medical records. The functional assessment was determined by phone interviews using the validated QuickDASH outcome measure. Mortality data were gathered from the medical record.
  
  
  RESULTS
  Pain was the presenting symptom in 93% of patients. Staphylococcal species were isolated in 73% of tissue specimens. Fifteen patients (37%) underwent primary closure and 25 patients (63%) underwent closure by secondary intention with application of negative-pressure wound therapy. There were four recurrences (10%), one after primary closure and three in the secondary intention group. No deaths occurred within 30 days of operation, and 5-year survival was 67%. Functional assessment using the QuickDASH outcome measure revealed minimal loss in upper extremity function after the procedure (preoperative score, 10 ± 3; postoperative score, 19 ± 6.8; n = 11). There was no difference in functional outcome comparing primary closure versus secondary intention (19 ± 4.4 versus 20 ± 8.2; p = 0.64).
  
  
  CONCLUSIONS
  Septic arthritis of the SCJ is routinely managed surgically at many centers. We report that primary closure with a muscle flap can achieve similar outcomes to secondary intention in selected patients. Furthermore, patients experienced minimal functional impairment at long-term follow-up.
authors.affiliation: Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Stefan S
authors.initials: SS
authors.lastname: Kachala
authors.affiliation: Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Desmond M
authors.initials: DM
authors.lastname: D'Souza
authors.affiliation: Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Lucileia
authors.initials: L
authors.lastname: Teixeira-Johnson
authors.affiliation: Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Sudish C
authors.initials: SC
authors.lastname: Murthy
authors.affiliation: Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Siva
authors.initials: S
authors.lastname: Raja
authors.affiliation: Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.affiliation: Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. Electronic address: raymond3@ccf.org.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Raymond
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D010147:Pain Measurement; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013247:Sternoclavicular Joint / Q000382:microbiology* / Q000503:physiopathology / Q000601:surgery*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology