23532 Open treatment of sternoclavicular dislocation, acute or chronic; with fascial graft (includes obtaining graft)

Name of the Procedure:

Open treatment of sternoclavicular dislocation, acute or chronic; with fascial graft (includes obtaining graft)

Summary

This surgical procedure is used to correct a dislocation of the sternoclavicular joint, where the clavicle (collarbone) meets the sternum (breastbone). A fascial graft, which is a piece of tough connective tissue, is used to stabilize the joint. The graft is taken from another part of the patient's body during the surgery.

Purpose

The procedure addresses acute (recent) or chronic (long-standing) dislocation of the sternoclavicular joint. The goal is to restore normal joint alignment and stability, alleviate pain, and improve function and range of motion in the shoulder.

Indications

• Persistent pain and instability in the sternoclavicular joint.
• Failure of conservative treatments like physical therapy, rest, and medications.
• Recurrent dislocations affecting daily activities.
• Chronic dislocation with deformity impacting shoulder movement.

Preparation

• The patient may be required to fast for 8 hours before the procedure.
• Medication adjustments might be needed, especially blood thinners.
• Preoperative imaging, such as X-rays or CT scans, may be required to assess the dislocation.
• Blood tests and an ECG to check overall health and readiness for surgery.

Procedure Description

1. Anesthesia is administered, typically general anesthesia to ensure the patient is asleep and pain-free.
2. A surgical incision is made over the sternoclavicular joint.
3. The dislocated joint is exposed and carefully repositioned.
4. A fascial graft is harvested, usually from the thigh or abdominal area.
5. The graft is shaped and placed to stabilize the joint.
6. Surgical screws or sutures may be used to secure the graft.
7. The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The surgery typically takes 2 to 3 hours, depending on complexity.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technician

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Damage to nearby blood vessels or nerves
• Graft failure or displacement
• Persistent instability or dislocation
• General anesthesia risks

Benefits

• Stabilization of the sternoclavicular joint
• Reduction in pain and discomfort
• Improved shoulder function and range of motion
• Decreased risk of recurrent dislocation

Recovery

• Post-procedure, the patient may need to stay in the hospital for 1-2 days.
• Pain management will include medications and possibly a sling for comfort.
• Limited shoulder movement for several weeks to allow healing.
• Follow-up appointments for wound checks and removal of sutures.
• Physical therapy typically begins after 4-6 weeks to restore function and strength.
• Full recovery can take several months.

Alternatives

• Non-surgical treatments such as physical therapy, bracing, and pain management.
• Minimally invasive procedures may be an option in some cases.
• Conservative management often involves a trade-off between symptom relief and complete joint stability.

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel pain. Postoperatively, pain and discomfort are managed with medication. The patient may experience stiffness and limited arm movement initially but can expect gradual improvement with physical therapy. Open communication with the medical team helps in managing pain and addressing any concerns during recovery.