HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Glenn N. Carlos Kenneth A. Kesler Mark W. Turrentine John W. Brown Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Carlos, G. N. Articles by Brown, J. W. Search for Related Content PubMed PubMed Citation Articles by Carlos, G. N. Articles by Brown, J. W.

J Thorac Cardiovasc Surg 1997;113:242-247
© 1997 Mosby, Inc.

GENERAL THORACIC SURGERY

AGGRESSIVE SURGICAL MANAGEMENT OF STERNOCLAVICULAR JOINT INFECTIONS

Received for publication May 21, 1996 revisions requested July 2, 1996; revisions received July 29, 1996 accepted for publication August 2, 1996. Address for reprints: Kenneth A. Kesler, MD, Department of Surgery, Thoracic Division, Indiana University School of Medicine, 545 Barnhill Dr., Emerson Hall, Room 212, Indianapolis, IN 46202.

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 débridement 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.

This article has been cited by other articles:

				V. Rachapalli, A. John, and M. J. Unsworth-White Mediastinal mass: A diagnostic conundrum J. Thorac. Cardiovasc. Surg., February 1, 2007; 133(2): 586 - 587. [Full Text] [PDF]

				H. M. Burkhart, C. Deschamps, M. S. Allen, F. C. Nichols III, D. L. Miller, and P. C. Pairolero Surgical management of sternoclavicular joint infections J. Thorac. Cardiovasc. Surg., April 1, 2003; 125(4): 945 - 949. [Abstract] [Full Text] [PDF]

				M. Haddad, D. E. Maziak, and F. M. Shamji Spontaneous sternoclavicular joint infections Ann. Thorac. Surg., October 1, 2002; 74(4): 1225 - 1227. [Abstract] [Full Text] [PDF]

				H. K. Song, T. S. Guy, L. R. Kaiser, and J. B. Shrager Current presentation and optimal surgical management of sternoclavicular joint infections Ann. Thorac. Surg., February 1, 2002; 73(2): 427 - 431. [Abstract] [Full Text] [PDF]

				C. H. Lim, J. Lim, M. J. Naik, and T. Agasthian Surgical Management of Sternoclavicular Joint Infection Asian Cardiovasc Thorac Ann, December 1, 2001; 9(4): 291 - 295. [Abstract] [Full Text] [PDF]