Surgical treatment of chest wall defects after purulent arthritis of the sternoclavicular joint

Abstract

The frequency of purulent arthritis of the sternoclavicular joint is less than 1 % of all joint infections. As a rule, the cause is the hematogenous spread of a generalized infection or trauma.Material and methods. The result of treatment of 24 patients (18 men, 6 women, mean age 38.4 years) with purulent arthritis of the sternoclavicular joints in the period from January 1, 2012 to December 30, 2022 is presented. The causes, clinical manifestations, options for surgical intervention and treatment outcome.Results. Most patients (20 people) complained of pain and tissue swelling in the area of the affected joint. In 4 patients, the main symptom was pain and limited mobility of the arm on the side of inflammation, while no external manifestations of the infectious process were detected. The main laboratory indicators of the inflammatory process were leukocytosis (mean (12 ± 1.6)·109/l) and an increase in CRP from 4 to 86 mg/l (mean 22 ± 4.2 mg/l). 50 % of patients had type 2 diabetes. In 14 patients, in addition to the destroyed sternoclavicular joint, there was damage to the rib/ribs, sternum. In 5 patients, the infectious process was bilateral. Each patient underwent resection of the clavicle and sternum together with the sternoclavicular joint; if the ribs were affected, they were resected. Intraoperative complication was registered in 1 case – erosive bleeding from the right subclavian vein. All patients were treated in two stages. The main pathogen was Staphilococcus aureus. After cleansing the wound, it was closed with local or displaced tissues. Histological examination of removed macropreparations in 18 patients revealed signs of acute osteomyelitis. 5 patients needed intensive care, of which 4 patients died: from progressive sepsis against the background of multiple organ failure and from progressive heart failure against the background of pulmonary edema. Recurrence of the infectious process in the surgical area occurred in 1 patient.Conclusions. Purulent arthritis of the sternoclavicular joint is not an independent disease. Hematogenous damage to this area is associated with a decrease in immunity and the development of a generalized infection. Treatment should be complex, aimed at surgical removal of pathologically altered structures and tissues, as well as intensive therapy to compensate for organ dysfunctions.

Keywords

• purulent arthritis
• sternoclavicular joint
• clavicle resection
• sternum resection
• osteomyelitis
• chest wall reconstruction
• muscle flaps