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Surgical Management of Sternoclavicular Joint Infection

Department of Cardiothoracic Surgery National Heart Centre Singapore, Republic of Singapore
For reprint information contact: Lim Chong Hee, FRCS Tel: 65 436 7598 Fax: 65 224 3632 email: limch88{at}hotmail.com Department of Cardiothoracic Surgery, National Heart Centre, 17 Third Hospital Avenue, Mistri Wing, Singapore 168752, Republic of Singapore.

Sternoclavicular joint infection is rare and tends to present insidiously in debilitated and immunocompromised patients. Between August 1996 and July 1998, we managed 7 patients with 8 sternoclavicular joint infections. Three were women. Their age ranged from 42 to 63 years. Five of the patients had significant associated medical conditions. Six patients, including 1 with bilateral involvement, underwent surgical resection, which consisted of radical excision of the involved joint, medial third of the clavicle, first and second ribs and adjacent muscular wall, and part of the manubrium. All of them underwent delayed reconstruction with either pectoralis major or latissimus dorsi flaps. There was 1 operative mortality from continuing sepsis from another source. All the surviving patients showed no sign of local recurrent infection and no functional deficits at follow-up. We conclude that infection of the sternoclavicular joint often presents late in debilitated patients. Medical therapy often fails in these cases. Radical excision is effective in eradicating the septic focus, and functional results after reconstruction are excellent.