Abstract
Introduction Septic arthritis of the sternoclavicular joint (SCJ) is a
rarity in everyday surgical practice with 0.5 – 1% of all joint infections.
Although there are several risk factors for the occurrence of this disease, also
healthy people can sometimes be affected. The clinical appearance is very
variable and ranges from unspecific symptoms such as local indolent swelling,
redness or restricted movement of the affected shoulder girdle to serious
consequences (mediastinitis, sepsis, jugular vein thrombosis). Together with
the
low incidence and the unfamiliarity of the disease among practicing doctors in
other specialties, this often results in a delay in the diagnosis, which in
addition to a significant reduction in the quality of life can also have
devastating consequences for the patient.
Patient and Method According to a stage-dependent procedure, the therapy
strategies range from antibiotic administration only to radical resection of
the
SC joint and other affected structures of the chest wall in severe cases with
the following necessity for flap reconstruction. The aspect of possible
post-interventional instability after resection of the SCJ receives little or
no
attention in the current literature. In the present case report of a
51-year-old, otherwise healthy gentleman with isolated monoarthritis of the
right SCJ with Escherichia coli (E. coli) shortly after two prostatitis
episodes, the possibility of a new surgical approach with a one-stage
eradication and simultaneous stabilization of the SCJ is presented. Therefore,
a
joint resection including extensive debridement is performed while leaving the
posterior joint capsule and inserting an antibiotic carrier. In the same
procedure, the SCJ is then stabilized with an autologous gracilis tendon graft
by using the “figure of eight” technique, which has become well established
particularly for anterior instabilities of the SCJ in recent years.
Results and Conclusion One year after operative therapy, the patient
presented symptom-free with an excellent clinical result (SSV 90%, CS89 points,
CSM 94 points, TF 11 points, DASH 2.5 points). It is concluded that in selected
cases with an infection restricted to the SCJ without major abscessing in the
surrounding soft tissues, the demonstrated procedure leads to good and excellent
clinical results with stability of the joint. If the focus of infection and germ
are known, stabilization using an autologous graft can be carried out under
antibiotic shielding. To the best of the authorsʼ knowledge, this surgical
procedure has not yet been described in the current literature. Depending on
the
extent of the resection, an accompanying stabilization of the SCJ should be
considered to achieve stable conditions and an optimal clinical outcome.
Key words SCJ - sternoclavicular joint infection - septic arthritis - SC joint reconstruction
- SC joint graft augmentation
