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Nonoperative treatment with a sling and swathe for six weeks
1%
8/1258
Nonoperative treatment with immediate active range of motion of the shoulder
0%
6/1258
Closed reduction in the emergency room
5%
58/1258
Open reduction and pinning of his medial clavicular physeal injury
63/1258
Reduction in the operating room with thoracic surgery back-up
89%
1120/1258
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Symptomatic acute posterior sternoclavicular dislocations in adolescents should undergo reduction with thoracic surgery back-up. If closed reduction is not successful (inability to reduce in up to 75% of cases), then open reduction is indicated. In patients younger than age 20-25, this is usually a physeal injury, as the medial clavicular physis does not close until this age range. Chronic anterior dislocations are recommended to be treated conservatively, especially if not symptomatic. The review article by Wirth and Rockwood notes the following complications with posterior dislocation: respiratory distress, venous congestion or arterial insufficiency, brachial plexus compression, and myocardial conduction abnormalities. They recommend reconstruction of the costoclavicular ligaments with resection of the medial clavicular head as needed for unstable injuries. The referenced article by Waters et al noted 100% excellent short-term outcomes in adolescents with open reduction and reconstruction of the costoclavicular ligament in pure dislocations or with suture fixation of the medial physis in physeal injuries.
3.8
(34)
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