Zentralbl Chir 2019; 144(S 01): S85-S86
DOI: 10.1055/s-0039-1694182
Vorträge – DACH-Jahrestagung: nummerisch aufsteigend sortiert
Georg Thieme Verlag KG Stuttgart · New York

Sternoclavicular joint infection: a single center experience

W Schreiner
1   Division of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Germany
,
W Dudek
1   Division of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Germany
,
I Mykoliuk
1   Division of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Germany
,
R Horch
2   Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Germany
,
H Sirbu
1   Division of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
04 September 2019 (online)

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    Background:

    Sternoclavicular joint (SCJ) infections are rare, but associated with relevant complications. There is no consensus on SCJ classification and management. We reviewed our experience in order to identify the predisposing factors for extended SCJ infection.

    Material and method:

    We retrospectively reviewed the data of patients with SCJ infection referred to our thoracic unit for surgery. Based on radiological findings mediastinal, cervical abscess formation and pleural extension were analysed as predisposing factors for extended SCJ infection.

    Result:

    From March 2008 to April 2019, 33 patients (28 men and 5 women) underwent surgery for SCJ infection. Median age was 57.7 (range 35 – 85) years. Predisposing risk factors were elicited in 27 patients (82%): liver cirrhosis in 7 (21%), steroid therapy in 6 (18%), radiation therapy in 4 (12%), diabetes mellitus in 3 (9%), chronic renal failure, adipositas and drug abuse in 2 (6%) each and pneumonia in 1 (3%). Surgery included: SCJ curettage followed by negative-pressure wound therapy (NPWT) with secondary wound closure in 4 patients (24%), SCJ resection followed by NPWT and muscle flap in 15 patients (46%), and SCJ resection with instillation NPWT and muscle flap in 10 patients (30%). The extended SCJ infections are correlated with higher perioperative mortality (3/4, 75%), impaired patient clinical status precluding adequate surgery (4/4, 100%), significantly prolonged hospital stay and higher rate on foam changes (p = 0.04 vs. 0.09, respectively). The trend to statistical significance for prolonged NPWT in presence of extended SCJ infection was identified (23 vs. 16 days; p = 0.109). Median follow up was 316 days (range 6 – 3101). No significant restriction in the arm movement in survivors was identified.

    Conclusion:

    Recognition of mediastinal, cervical abscess formation and pleural extension predispose to extended SCJ infections. Based on this criterion the local surgical approach was applicable to the limited form, whereas the extended form required prolonged NPWT and hospital stay as well as often muscle flap transposition.


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