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Treatment of Sternoclavicular Joint Infections with Proximal Clavicle Resection and Pectoralis Transposition: The Functional Consequences
Joshua Choo, MD
Jessica Vavra, MD
Rachal Safeek, BA, MPH
Braden, Wilhelmi, MD
The University of Louisville
2021-02-15
Presenter: Jessica Vavra, MD
Affidavit:
Dr Vavra developed this project, and presented it to Dr. Joshua Choo who both noticed increasing prevalence of sternoclavicular infections of recent without postoperative difficulties with Dr. Choo being the reconstructive surgeon performing these procedures.
Director Name: Bradon Wilhelmi, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Sternoclavicular joint infections (SCJI) have become more common with the opioid crisis and the increasing prevalence of intravenous drug abuse (IVDA). Resection of the proximal clavicle and pectoralis muscle transposition is part of the armamentarium for the treatment of such infections. However, long-term effect on shoulder function is not clear.
A retrospective review was conducted on a series of 15 cases of sternoclavicular joint infections, all of which were treated with proximal clavicle resection and pectoralis muscle flap coverage. The Shoulder Disability Questionnaire (SDQ) was used to assess postoperative function.
Of the 15 cases, 3 patients were lost to follow-up. One patient was excluded due to subsequent shoulder surgery, and a second excluded due to medical issues that precluded a reliable history. Other than one patient who had continued IVDA, no recurrence was noted. Using the SDQ, the functional status limitation in the remaining 10 cases was evaluated. Despite differences in etiologies, the long-term shoulder disability was minimal (mean score of 6 ± 9). When the SCJI was attributed to IVDA, however, the long-term shoulder disability was significantly higher (mean score of 33 ± 16, p<0.05).
Despite differing etiologies of SCJI, resection of the proximal clavicle and pectoralis muscle flap transposition generally results in minimal long-term shoulder disability. In cases due to IVDA, however, the long-term shoulder disability score was significantly higher, despite resolution of infection. Possible explanations of this finding are the self-reporting nature of the SDQ and the well-documented issues with chronic pain in patients with opioid dependency.
