Anterior Sternoclavicular luxation with clavicle fracture

Dear all,

I've suffered a bad mountain bike crash 10 days ago. In the emergency room they performed an X-ray and echography. I've been released from emergency room after 2 hours with the following diagnostic and recommendations: "1/3 medial left clavicle fracture (Fissure - no reduction necessary) and left sternoclavicular luxation, ribs contusions and other bruises. We recommend orthopedic surgeon evaluation regarding the sternoclavicular luxation". I've gone 2 days later to the orthopedist that performed a "Figure of a 8 Wrap" exactly like this one: http://www.youtube.com/watch?v=1SCMhhCPBOE&feature=related and said that I should wear this for 3 weeks. After that I should begin to recover normal mobility (function) but there will be esthetical issues (a bump in my chest). He said that a surgery is very risky and if in my place he will just accept the esthetical issue. After this visit I've read some things over the net and realize how dangerous this lesion is and got scared and decide to ask here some questions. Forgot to add that I'm a 29 years old male, 197 cm and 92 kg. In the first days after the accident I've had back neck pains, left neck muscle pains, swallowing pains, shoulder pain and bad ribs pain, pain when lifting my head when laid horizontally in bead and low fever (37.5 C). Now I just have some ribs pain and very light neck pain, the others almost entirely gone away.

Questions:
1. Why the doctors did not tried a close reduction (emergency doctors or orthopedist)?
2. Should I also have a CT or MRI for checking the structures behind the clavicle?
3. Is the "Figure of a 8 wrap" enough for treating my lesion?
4. Left untreated, this lesion can cause damage to the structures behind the sternoclavicular joint? I suppose that this is an anterior sternoclavicular luxation, not posterior one as there is a large bump there.
5. I have a bump in my left side of the sternoclavicular joint. Is there any chance that over time this bump will become smaller or be covered by muscular tissue or any other trick?
6. Regarding functionality, what should I expect? Will I be able in the future to carry loads, move my hand normally, and do sports like skiing, soccer? What are the risks of another fall on the same shoulder?
7. What is the recovery period? Will I be able to drive a car after the "Figure of a 8 wrap" will be removed?
8. Regarding ribs contusions pains, how much time it will take for them to disappear?

Thank you very much.

[S. Kaul, MD]

Hi there!

1. A closed reduction is often not required for such injuries. It is only needed when fractures or subluxated segments cannot be reduced at an acceptable alignment through a closed reduction. Besides, a surgery also runs the risk of damage to surrounding vital structures.
2. If your doctor did not suggest a CT/ MRI based on a physical examination and x-rays, it is likely to be unnecessary.
3. The figure of 8 bandage would be sufficient for adequate management. However results would need to be checked after a few weeks.
4. Yes, this is likely to be an anterior subluxation. The possible complications, if left untreated, depend on the severity and the position of the injury and are more likely with dislocations as compared to subluxations.
5. The cosmetic deformity is likely to remain.
6 Yes, you should be able to unction normally after the injury heals. However one should not push it to the extreme since the healed region would always tend to be slightly weaker than a normal bone (like fractures or subluxations elsewhere in the body)
7. It may take 2-4 months for a complete recovery though the sling would be removed in a few weeks after which you would be advised physiotherapy. You should be able to drive a car after a few days/ weeks of physiotherapy, depending on the progress.
8. Bone contusions may take anywhere between a few weeks to an year to heal. The average time being 3-6 months.
Hope this helps.

Take care!

[S. Kaul, MD]

Hi there!

1. A closed reduction is often not required for such injuries. It is only needed when fractures or subluxated segments cannot be reduced at an acceptable alignment through a closed reduction. Besides, a surgery also runs the risk of damage to surrounding vital structures.
2. If your doctor did not suggest a CT/ MRI based on a physical examination and x-rays, it is likely to be unnecessary.
3. The figure of 8 bandage would be sufficient for adequate management. However results would need to be checked after a few weeks.
4. Yes, this is likely to be an anterior subluxation. The possible complications, if left untreated, depend on the severity and the position of the injury and are more likely with dislocations as compared to subluxations.
5. The cosmetic deformity is likely to remain.
6 Yes, you should be able to unction normally after the injury heals. However one should not push it to the extreme since the healed region would always tend to be slightly weaker than a normal bone (like fractures or subluxations elsewhere in the body)
7. It may take 2-4 months for a complete recovery though the sling would be removed in a few weeks after which you would be advised physiotherapy. You should be able to drive a car after a few days/ weeks of physiotherapy, depending on the progress.
8. Bone contusions may take anywhere between a few weeks to an year to heal. The average time being 3-6 months.
Hope this helps.

Take care!

[AlexN82]

Hi Kaul,

Thank you very much for your response.

AlexN