Sternoclavicular joint purulent arthritis and its complications: tactics of surgical treatment, results of restoration
DOI:
https://doi.org/10.14739/2310-1210.2020.6.218451Keywords:
sternoclavicular joint, purulent arthritis, surgeryAbstract
Aim: to improve the treatment and diagnostic tactics in patients with sternoclavicular joint purulent arthritis.
Materials and methods. A prospective, single-center study was conducted which included 30 patients with acute purulent arthritis of the sternoclavicular joint and its complications. Patients were divided into 2 groups based on the operative technique: the main – 20 patients who were operated following the proposed surgical tactics, and the control – 10 patients.
Results. The cause of sternoclavicular joint purulent inflammation, clavicle and rib osteomyelitis was a hematogenous dissemination of microbial infection with concomitant diseases in most cases (n = 22; 73.3 %). The criteria for the short-term treatment results assessment such as the surgery duration, total blood loss, termination of exudation and removal of drainage tubes, length of hospital stay, the dynamics of changes in the inflammatory response markers did not differ significantly between the groups.
The dynamics of pain syndrome according to VAS did not differ on the second day 66.5 (65.0; 67.0) versus 64.5 (61.0; 69.0), P = 0.201). Similar result was obtained on day 5: 49.5 (47.5; 54.0) versus 53.5 (51.0; 54.0), P = 0.314. However, pain was significantly reduced in the main group on the 10th postoperative day 27.0 (23.5; 30.0) versus 37.5 (34.0; 39.0), P = 0.005. A much more restoration of the movement amplitude and better functional outcomes on the QuickDASH scale were obtained in the main group (P = 0.017).
Conclusions. Diagnosis of sternoclavicular joint purulent arthritis includes an analysis of the clinical picture of the disease and the results of radiologic imaging. Active surgical tactics and anatomically determined choice of the clavicle resection site provide good short-term results. The introduced comprehensive approach to the diagnosis and surgical treatment of sternoclavicular joint purulent arthritis facilitate obtaining better functional outcomes in comparison with traditional multi-stage tactics.
References
Ali, B., Shetty, A., Qeadan, F., Demas, C., & Schwartz, J. D. (2020). Sternoclavicular Joint Infections: Improved Outcomes With Myocutaneous Flaps. Seminars in Thoracic and Cardiovascular Surgery, 32(2), 369-376. https://doi.org/10.1053/j.semtcvs.2019.12.007
Tapscott, D. C., & Benham, M. D. (2020). Sternoclavicular Joint Infection. In: StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK551721/?report=reader#_NBK551721_pubdet_
Opoku-Agyeman, J., Matera, D., & Simone, J. (2019). Surgical configurations of the pectoralis major flap for reconstruction of sternoclavicular defects: a systematic review and new classification of described techniques. BMC Surgery, 19(1), Article 136. https://doi.org/10.1186/s12893-019-0604-7
Opoku-Agyeman, J., Perez, S., Behnam, A., & Matera, D. (2019). Reconstruction of sternoclavicular defect with completely detached pectoralis major flap. Journal of Surgical Case Reports, 2019(4), Article rjz122. https://doi.org/10.1093/jscr/rjz122
von Glinski, A., Yilmaz, E., Rausch, V., Koenigshausen, M., Schildhauer, T. A., Seybold, D., & Geßmann, J. (2019). Surgical management of sternoclavicular joint septic arthritis. Journal of Clinical Orthopaedics and Trauma, 10(2), 406-413. https://doi.org/10.1016/j.jcot.2018.05.001
Kawashiri, S. Y., Edo, Y., & Kawakami, A. (2019). Early Detection of Inflammation and Joint Destruction Revealed by Ultrasound in a Patient with Sternoclavicular Septic Arthritis. Internal Medicine, 58(6), 865-869. https://doi.org/10.2169/internalmedicine.1782-18
Kang, B. S., Shim, H. S., Kwon, W. J., Lim, S., Park, G. M., Lee, T. Y., & Bang, M. (2019). MRI findings for unilateral sternoclavicular arthritis: differentiation between infectious arthritis and spondyloarthritis. Skeletal Radiology, 48(2), 259-266. https://doi.org/10.1007/s00256-018-3023-4
McAninch, S. A., Smithson, C., Juergens, A. L., Collins, J. N., & Nanda, A. (2018). Sternoclavicular Joint Infection Presenting as Nonspecific Chest Pain. The Journal of Emergency Medicine, 54(2), 229-231. https://doi.org/10.1016/j.jemermed.2017.11.026
Murga, A., Copeland, H., Hargrove, R., Wallen, J. M., & Zaheer, S. (2017). Treatment for sternoclavicular joint infections: a multi-institutional study. Journal of Thoracic Disease, 9(6), 1503-1508. https://doi.org/10.21037/jtd.2017.05.76
Schipper, P., & Tieu, B. H. (2017). Acute Chest Wall Infections. Surgical Site Infections, Necrotizing Soft Tissue Infections, and Sternoclavicular Joint Infection. Thoracic Surgery Clinics, 27(2), 73-86. https://doi.org/10.1016/j.thorsurg.2017.01.001
Chen, H., Ji, X., Hao, M., Zhang, Q., & Tang, P. (2016). A three-stage procedure using bone transportation for the treatment of sternoclavicular infectious arthritis. Journal of Orthopaedic Surgery and Research, 11(1), Article 152. https://doi.org/10.1186/s13018-016-0480-0
Nguyen, M., Moffatt-Bruce, S. D., Merritt, R. E., & D’Souza, D. M. (2016). Clinical Effectiveness of Negative Pressure Wound Therapy Following Surgical Resection of Sternoclavicular Joint Infection: A Case Report. Cureus, 8(10), Article e815. https://doi.org/10.7759/cureus.815
Kachala, S. S., D’Souza, D. M., Teixeira-Johnson, L., Murthy, S. C., Raja, S., Blackstone, E. H., & Raymond, D. P. (2016). Surgical Management of Sternoclavicular Joint Infections. The Annals of Thoracic Surgery, 101(6), 2155-2160. https://doi.org/10.1016/j.athoracsur.2016.01.054
Tanaka, Y., Kato, H., Shirai, K., Nakajima, Y., Yamada, N., Okada, H., Yoshida, T., Toyoda, I., & Ogura, S. (2016). Sternoclavicular joint septic arthritis with chest wall abscess in a healthy adult: a case report. Journal of Medical Case Reports, 10(1), Article 69. https://doi.org/10.1186/s13256-016-0856-0
Whitlark, J. D., Kirollos, J. A., & Jackson, S. M. (2016). Simplified Method for Treating Osteomyelitis of the Sternoclavicular Joint. The Annals of Thoracic Surgery, 101(3), 1211-1212. https://doi.org/10.1016/j.athoracsur.2015.08.053
Kuhtin, O., Schmidt-Rohlfing, B., Dittrich, M., Lampl, L., Hohls, M., & Haas, V. (2015). Behandlungsstrategie der septischen Arthritiden des Sternoklavikulargelenks. Zentralblatt fur Chirurgie, 140(Suppl. 1), S16-S21. https://doi.org/10.1055/s-0034-1382922
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
