抄録
68-year-old man who was brought to our hospital after a motorcycle crash complained of difficulty breathing, right chest pain, and right shoulder pain. An anteroposterior roentgenogram of the chest revealed a markedly inferior displacement of the medial end of theright clavicle as well as subcutaneous emphysema. Computed tomography (CT) demonstrated left multiple rib fractures, posterior dislocation of the medial end of the right clavicle with compression of the adjacent structures, and mediastinal emphysema. We consulted with an anesthetist and a thoracic specialist about immediate reduction of posterior dislocation of the medial end of the clavicle. They suggested that they had to confirm whether there was a serious injury to the trachea before administering general anaesthesia, because mediastinal emphysema was present. They suggested delayed bronchoscopy for fear that further fatal injuries to the trachea, which might already exist, by emergency bronchoscopy were induced. Because the patient complained of dyspnea after the bronchoscopy on the third day, an anteroposterior roentgenogram of the chest was taken. It showed a normal relationship between the medial end of the right clavicle and the sternum, although the subcutaneous emphysema had increased and a right pneumothorax was present. A chest tube was inserted to treat the increased pneumothorax. CT showed a complete reduction of the dislocation of the right sternoclavicular joint. A follow-up evaluation 1 year later showed complete resolution of the pain with normal shoulder motion and no limitation.
Posterior sternoclavicular dislocation is a rare injury. To our knowledge, there are no reports of an unexpected reduction of posterior sternoclavicular dislocation. Therefore, this report appears to be the first documented case of unexpected reduction of a posterior sternoclavicular dislocation. A mechanism for the unexpected reduction of the dislocation was proposed.
