ORIGINAL ARTICLE Management of sternoclavicular dislocation in young children: considerations about diagnosis and treatment of four cases J. Gil-Albarova • S. Rebollo-Gonza ´lez • V. E. Go ´mez-Palacio • A. Herrera Received: 9 March 2012 / Accepted: 31 December 2012 Ó Istituti Ortopedici Rizzoli 2013 Abstract The records of 4 children of under 14 years of age treated at our institution for traumatic sternoclavicular dislocation (SCJ) were reviewed. Closed reduction in posterior SCJ after computed tomography (CT) was suc- cessful as immediate procedure. For anterior SCJ insta- bility, open reduction and SCJ reconstruction obtained satisfactory results. Conservative treatment of SCJ sub- luxation for asymptomatic children was sufficient. Radio- graphs in ‘‘serendipity view’’ were useful for confirming reduction and stability in children. No postoperative CT was needed for this purpose. Closed reduction in posterior SCJ dislocation and surgical treatment in anterior SCJ dislocation in young children can provide stability and a satisfactory return to a normal function, but with some limitation when intense or competitive shoulder motion is required during sport. Young children and parents should be aware about this possibility. Conservative treatment of SCJ subluxation for asymptomatic children is useful. Reflection is required regarding the correct imaging examination after treatment to check stable reduction in a SCJ injury. Keywords Sternoclavicular joint Á Dislocation Á Children Introduction Traumatic sternoclavicular joint (SCJ) dislocations are unusual, representing about 3 % of all shoulder girdle injuries, and less than 1 % of all skeletal dislocations [1–5]. The SCJ is a true diarthrodial joint between the medial clavicle and the clavicular notch of the sternum, with an important role in shoulder stability and motion [1, 4]. True dislocations are rare in children, because the medial cla- vicular physis does not ossify until approximately 21–24 years of age. Therefore, in young people, these injuries may be detected as displaced physeal fractures [1, 2, 4–11] but not infrequently are observed as true dislo- cations [3, 4, 6, 9, 12–15]. SCJ fracture dislocations usually arise from high-energy mechanisms, and both direct and indirect trauma to the ipsilateral shoulder may cause the injury. Displacement of the medial clavicle can either be anterior (95 %) or more infrequently posterior, increasing the risk of mediastinal compression and associated injuries [3–13, 15], and, very infrequently, the dislocation is superomedial [13, 17, 18]. Different clinical presentations may be seen according to the direction of displacement, the time of diagnosis and the patient’s age. Both as diagnostic approach and for confirming reduc- tion after treatment, conventional radiographs, different radiological views, ultrasound examination, computed tomography or even MRI are suggested as eligible methods [1–15, 17, 18]. However, to our knowledge, most cases in the literature refer to adult patients and adolescents but few studies include only cases of young children or even the newborn [4, 7, 10, 13]. The principles of SCJ fracture-dis- location treatment [1] consider the acuity or chronicity of the injury, the direction of displacement and the severity of the symptoms. But a reasonable doubt about the selection J. Gil-Albarova (&) Á S. Rebollo-Gonza ´lez Á V. E. Go ´ mez-Palacio Á A. Herrera Servicio de Cirugı ´a Ortope ´dica y Traumatologı ´a, Hospital Universitario Miguel Servet, P8 Isabel la Cato ´lica 1-3, 50009 Zaragoza, Spain e-mail: jgilalba@unizar.es 123 Musculoskelet Surg DOI 10.1007/s12306-012-0240-1