Aggressive surgical management of sternoclavicular joint infections

G. N. Carlos, Kenneth Kesler, J. J. Coleman, L. Broderick, Mark Turrentine, John Brown

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background: Although the sternoclavicular joint is an unusual site for infection, thoracic surgeons may preferentially be called on to coordinate management of cases refractory to antibiotic therapy because of the anatomic relationship of this joint to major vascular structures. Methods: Since 1994 we have surgically managed nine sternoclavicular joint infections in eight patients. Associated medical problems were frequent and included diabetes mellitus (n = 2), end-stage renal disease (n = 2), hematologic disorders (n = 2), and multiple joints affected by sepsis (n = 4). Open joint exploration with drainage and debridement with the use of general anesthesia was performed in four patients. The remaining four patients (one with bilateral sternoclavicular joint infections) had computed tomographic evidence of diffuse joint and surrounding bone destruction with infection extending into mediastinal soft tissues. Surgical therapy for these five joint infections involved en bloc resection of the sternoclavicular joint with an ipsilateral pectoralis major muscle covering the bony defect. Results: There were two deaths unrelated to the surgical procedure. After a mean follow-up of 20 months, the remaining six survivors (seven joints) have complete healing with no apparent limitation in the range of motion even after en bloc resection. Conclusions: Most cases of early sternoclavicular joint infections will respond to conservative measures. However, when radiographic evidence of infection beyond the sternoclavicular joint is present, en bloc resection, although seemingly aggressive, results in immediate eradication of all infection with negligible functional morbidity. Prolonged antibiotic therapy or continued local drainage procedures appear to have little value in these cases, adding only to patient care costs and the potential sequelae of chronic infections.

Original languageEnglish
Pages (from-to)242-247
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume113
Issue number2
DOIs
StatePublished - 1997

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Sternoclavicular Joint
Joints
Infection
Drainage
Pectoralis Muscles
Anti-Bacterial Agents
Case Management
Debridement
Articular Range of Motion
General Anesthesia
Chronic Kidney Failure
Blood Vessels
Survivors
Sepsis
Patient Care
Diabetes Mellitus
Thorax
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Aggressive surgical management of sternoclavicular joint infections. / Carlos, G. N.; Kesler, Kenneth; Coleman, J. J.; Broderick, L.; Turrentine, Mark; Brown, John.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 113, No. 2, 1997, p. 242-247.

Research output: Contribution to journalArticle

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