Working Diagnosis:
Left Sternoclavicular Joint Posterior Dislocation.

Treatment:
Patient was immediately admitted from the radiology department to the emergency room. He was then transferred to a trauma center for further evaluation and treatment. Subsequently he had a succesful open reduction with internal fixation of displaced medial clavicle physeal fracture.

Outcome:
He did well post-operatively, and had a full recovery.

Author's Comments:
Sternoclavicular dislocations are uncommon. It has been reported that posterior sternoclavicular dislocation account for less than 5 percent of all shoulder girdle injuries and up to 30 percent of these can be life threatning. While majority of these are anterior, posterior dislocation injuries are far more rare and serious. Traumatic posterior dislocations are a concern because of the risk of injury or compression of underlying mediastinal structures. Unfortunately, these are very hard to diagnose, as routine imaging may not show posterior dislocations, requiring a specialized view: the serendipity view. The serendipity view is preferred when determining the relative position of clavicle to the manubrium in order to figure out the direction of dislocation, as the beam is centered 40 degrees cephalic tilt centered over the sternum Given the chronicity and symptoms our patient had, we obtained a CT scan as it a gold standard for diagnosis. Treatment can be open or closed reductions, however given the concern for damage to underlying structures, open reduction is highly advised. Our patient had a delayed and symtomatic presentation and thus a open reduction.

Editor's Comments:
Posterior SC dislocations require emergent evaluation and care and this injury can cause compression of the airway and subclavian vessels. Providers should take a careful history and perform a careful clinical examination to look for associated signs/symptoms including dyspnea, stridor, dysphagia. When a patient presents with a suspected posterior SC dislocation, they should undergo emergent evaluation that includes CT .

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