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Sternoclavicular Joint Dislocation: A Systematic Review and Meta-analysis.

OBJECTIVES: This meta-analysis was performed to answer the following questions: (1) What is the expected outcome of sternoclavicular (SC) dislocations left untreated? (2) What are the indications for closed reduction of SC dislocations? (3) What are the indications for open reduction of SC dislocations? and (4) Does the evidence support the need for a cardiothoracic surgeon to be available for the open reduction of a SC dislocation?

DATA SOURCES: Articles were obtained from the database EBSCOhost and supplemented by hand searching of bibliographies of included references. A search using the following terms: SC joint AND (dislocation OR injuries OR vascular injury OR cardiovascular surgeon) of the English-language literature from 1970 to 2018 on the topic of SC joint dislocations was performed.

STUDY SELECTION: Studies were included if they contained clinical data on one or more of our study objectives. Articles were included if they contained participants presenting with an acute (<3 week old) SC joint dislocation who were 16 years of age or above. A total of 92 cases fit this participant criteria.

DATA EXTRACTION: Studies chosen based on the inclusion and exclusion criteria were assessed for level of evidence and were then carefully reviewed for data pertaining to the current study questions. Data from individual articles were recorded in a spreadsheet program and grouped appropriately.

DATA SYNTHESIS: Individual cases of acute SC joint dislocations reported in the literature were noted by the authors. The cases were organized into a spreadsheet, which allowed for the calculation of total patients treated and with what treatment option. Complications that followed treatment were also noted, allowing for a quantitative analysis of patient outcome.

CONCLUSIONS: Based on the current body of literature, closed reduction should be attempted in the acute setting and open treatment performed in cases of failed closed reduction in posterior SC dislocations.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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