complications and challenges of sternoclavicular hook plates for treating sternoclavicular joint dislocations

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Methods This study retrospectively analyzed the use of sternoclavicular (SC) hook plates for treating sternoclavicular joint (SCJ) dislocations, with a particular focus on identifying hardware-related complications such as plate breakages and fixation failures. A cohort of patients who underwent SC hook plate fixation was evaluated based on clinical outcomes, functional recovery, and the occurrence of complications. Data collection included postoperative imaging (X-rays and CT scans) to assess joint repositioning and hardware integrity, as well as functional assessments using the Constant Shoulder Score (CSS) and Visual Analog Scale (VAS) for pain. Results The utilization of hook plates led to successful joint stabilization and notable functional enhancement, as evidenced by the mean CSS scores increasing from 36.4 preoperatively to 86.6 postoperatively, and VAS scores decreasing from 7.2 to 1.6. However, 4 patients (8.7%) experienced plate breakages with no redislocation, and 1 patient (2%) encountered fixation failure necessitating revision surgeries. No major neurovascular complications were reported. Conclusions Despite providing effective stabilization for SCJ dislocations, sternoclavicular hook plates are associated with hardware-related issues, including plate breakages and fixation failures. Enhancements in implant design, surgical procedures, and patient selection are imperative in mitigating these concerns and enhancing long-term outcomes. Future research should prioritize the development of more robust implants and exploration of alternative treatment modalities. Sternoclavicular Hook SCJ Dislocation Hardware Failure Joint Stabilization Postoperative Outcomes Figures Figure 1 Figure 2 Figure 3 Introduction Sternoclavicular joint (SCJ) dislocations, although uncommon, pose significant challenges in trauma surgery due to the joint's crucial role in shoulder stability and its proximity to vital structures [ 1 ] . Dislocations are categorized as anterior, being more prevalent but less severe, or posterior, less common yet potentially life-threatening due to the risk of compression on the trachea, blood vessels, or esophagus [ 2 ] . Treatment options for SCJ dislocations vary from conservative approaches like closed reduction and immobilization for stable anterior dislocations to surgical interventions such as open reduction and internal fixation (ORIF) or ligament reconstruction for posterior dislocations or cases of persistent instability [ 3 – 5 ] . The introduction of sternoclavicular hook plates has advanced the surgical approach by providing greater mechanical stability, particularly in traumatic cases, and allowing for early mobilization [ 6 – 8 ] . Despite these benefits, the technique may be associated with complications like hardware failure, plate loosening, and functional impairments, underscoring the need for further procedural refinement and long-term outcome assessment. Consequently, there exists an urgent necessity for a thorough evaluation of the risks and advantages linked to the use of hook plates in treating SCJ dislocations. This study seeks to bridge this gap through an in-depth scrutiny of the inherent challenges and complications associated with this approach. The primary objective of this research is to systematically evaluate the frequency, types, and consequences of hardware and functional complications, as well as offer insights on optimizing surgical techniques and implant design to enhance patient outcomes. Methodology 1.1 Study Design This retrospective cohort analysis involved 46 patients who underwent treatment with sternoclavicular hook plates for traumatic SCJ dislocations between 2015 and 2022 at our hospital. Inclusion criteria focused on patients with acute traumatic SCJ dislocations who had failed manual repositioning, re-dislocation after repositioning or could not tolerate prolonged joint immobilization, necessitating surgical intervention. Exclusion criteria included patients with chronic SCJ injuries, those managed conservatively, and individuals with underlying conditions impacting bone healing. 1.2 Surgical Technique The surgical procedure commenced with general anesthesia administration and patient positioning in the supine orientation. A unique inverted "7"-shaped incision was made along the upper midline of the sternum. The periosteum on the affected side of the sternum and the attachment of the sternocleidomastoid muscle were meticulously detached using a periosteal dissector. Subsequently, a drill guide mold was positioned at the sternum's midline, followed by drilling a 4.2mm hole perpendicular to the posterior wall. The sternum's thickness was gauged, and the hole was cleared of bone debris. The introducer cable was then tightened to insert the head-end guide wire into the sternal orifice. The steel plate trial head was inserted into the sternal hole from the posterior side after securing the nut to the guide mold with the "T" handle rotation. The sternoclavicular joint was reset by pulling the proximal clavicle and applying downward pressure. The appropriate sternum locking hook plate from Zhejiang CANWELL Medical Equipment Co. was selected based on the trial mold and measured thickness. The cable was tightened to insert the hook into the sternal orifice, and the plate was placed over the clavicle. Subsequent to drilling and tapping the clavicle, three screws were inserted, and joint stability was assessed. If instability persisted, a shim-like nut and lock nut were installed to secure the joint; otherwise, the cable nut was removed. The sternocleidomastoid muscle and sternoclavicular joint capsule were sutured with intermittent sutures to close the incision (Fig. 1). 1.3 Postoperative Management: Two weeks post-surgery, patients were fitted with a triangular shoulder sling, and gradual functional exercises were initiated. Restricted shoulder abduction and flexion within 90 degrees were advised for the initial one months, accompanied by avoidance of strenuous activities for a further three months. The sternoclavicular hook plate removal was generally recommended between 6 to 12 months post-surgery. 1.4 Data Collection Shoulder function and pain were measured pre and postoperatively utilizing the Constant Shoulder Score (CSS) and Visual Analog Scale (VAS), respectively. Radiographic imaging, including X-rays and CT scans, was utilized to monitor joint repositioning, evaluate hook plate placement accuracy, and assess hardware integrity throughout recovery. Intraoperative parameters, such as operative time, blood loss, and complications, were documented. Patients were closely monitored for an average of 26.7 months during postoperative follow-up through clinic visits or phone calls conducted at specific intervals. 1.5 Statistical Analysis A comparative analysis between preoperative and postoperative outcomes using statistical tests like paired t-tests was conducted to assess changes in joint function and pain levels, contributing to a holistic evaluation of the effectiveness of hook plates in enhancing patient recovery. Results 2.1 Patient Demographics and Clinical Data The study cohort comprised 46 individuals who underwent treatment with sternoclavicular hook plates for SCJ dislocations between 2015 and 2022. The demographic analysis revealed a mean age of 49.3 years (range: 28 to 73 years), with a predominant representation of male patients (44 males, 2 females). High-energy trauma, primarily resulting from traffic accidents (44 cases) and sports injuries (2 cases), was the prevalent mechanism of injury. Notably, the breakdown of dislocation types indicated 42 cases of anterior dislocations and 4 cases of posterior dislocations. This categorization is significant given the increased risks associated with posterior dislocations, emphasizing the importance of utilizing hook plates in such scenarios. 2.2 Surgical Outcomes The average operative duration for the 46 patients undergoing sternoclavicular hook plate fixation varied between 55 and 95 minutes, with a mean of 65.2 ± 8.4 minutes. Notably, there were no instances of nerve or vascular injuries reported as intraoperative complications, and the average blood loss during surgery was minimal at 46.2 ± 14.6 mL. Preoperatively, the mean Constant Shoulder Score (CSS) was 36.4 ± 4.8 points (range: 28–46 points). At the final follow-up, the postoperative mean CSS score significantly improved to 86.6 ± 6.2 points (range: 80–92), p < 0.05, indicating a statistically significant difference. Moreover, the mean Visual Analog Scale (VAS) score demonstrated improvement from 7.2 ± 1.4 (range: 5–8) preoperatively to 1.6 ± 0.4 (range: 0–3) at the final follow-up, p < 0.05, denoting a statistically significant difference. Radiographic assessments postoperatively, comprising X-rays and CT scans, consistently revealed successful joint repositioning across all cases, with the hook plates effectively maintaining proper sternoclavicular joint alignment. Throughout the follow-up period, hardware integrity remained intact with no instances of significant hardware loosening or displacement immediately post-surgery, although a few cases of hardware-related complications emerged during recovery. 2.3 Complications and Hardware Issues Following the utilization of sternoclavicular hook plates, the study identified several hardware-related complications. Notably, a 66-year-old male patient (2%) experienced fixation failure and redislocation within 10 days post-surgery, necessitating revision surgery (Fig. 2). Additionally, during follow-ups, plate breakages were noted in 4 patients (8.7%) (Fig. 3), although these occurrences did not lead to redislocation or immediate revision surgeries. Discussion The study demonstrated successful joint repositioning in the majority of cases, as verified by postoperative radiographic evaluations. Most patients exhibited significant functional recovery, evidenced by improvements in the Constant Shoulder Score (CSS) and Visual Analog Scale (VAS) for pain, signifying effective shoulder function restoration. However, the study identified complications, including hardware failure in the form of plate breakages (8.7%) and one case (2%) of fixation failure resulting in redislocation. These hardware-related issues highlight a substantial risk associated with hook plate usage, particularly in older individuals with osteoporosis or those who are more physically active. Despite these challenges, most patients maintained joint stability and achieved positive functional outcomes postoperatively, although those experiencing hardware complications necessitated further interventions and had extended recovery periods. It emphasizes the necessity of closely monitoring hardware integrity and considering patient-specific characteristics to mitigate risks and enhance long-term results. While no instances of neurovascular injury were reported, hardware breakages did not mandate revision surgeries, prolong recovery, or significantly affect overall outcomes. These results underscore the balance between the mechanical stability provided by hook plates and the potential risks of hardware-related complications, especially in complex dislocations or high-demand patient populations. Comparison between sternoclavicular hook plates and other techniques, such as acromioclavicular (AC) hook plates and ligament repair (utilizing artificial or autologous ligaments), reveals distinct differences. Sternoclavicular hook plates offer immediate mechanical stability, enabling early mobilization and accelerated recovery in traumatic SCJ dislocations. Similarly, AC hook plates are commonly used for AC joint dislocations due to their robust fixation properties and ability to maintain reduction. Qu et al. [ 7 ] reported successful treatment of 10 patients with anterior SCJ dislocation using AC hook plates without complications, with a follow-up of 16.9 months, providing sufficient short-to-medium-term outcomes but lacking the long-term complications observed in this study. Ligament repair, whether with artificial or autologous grafts, adopts a more biological approach relying on the body's natural healing mechanisms. This method typically entails longer recovery periods due to the dependence on ligament healing and carries a heightened risk of redislocation in severe trauma cases compared to the immediate stabilization provided by hook plates. Nevertheless, ligament repair offers the advantage of avoiding hardware complications and may be preferable in less severe dislocations where the risk of hardware failure is unnecessary [ 9 – 12 ] . This study significantly contributes by addressing complications, challenges, and long-term outcomes associated with sternoclavicular (SC) hook plates in SCJ dislocation treatment, complementing the generally favorable outcomes reported in earlier studies [ 6 – 8 , 13 , 14 ] , While past research indicated no complications, wound infections, or plate/screw breakages, this study highlights potential risks, providing a more comprehensive understanding of long-term performance and hardware-related complications in specific patient subsets. By uncovering this novel complication, absent in prior studies, this research underscores potential gaps in earlier evaluations, emphasizing the importance of comprehensive long-term monitoring and hardware performance analysis. This discovery suggests that previous studies may have underestimated certain risks over extended periods or in specific patient groups, enhancing clinical practice refinement through rigorous postoperative follow-up and surgical technique adaptation to proactively address future treatment challenges. Furthermore, this revelation underscores the ongoing need for plate design innovation and continued research to embrace the full spectrum of outcomes linked with sternoclavicular hook plates. The sternoclavicular hook plate has significantly advanced shoulder trauma surgery by delivering immediate mechanical stability for acute, traumatic dislocations. Its capacity to effectively realign the joint, particularly in intricate posterior dislocations, reduces the risk of redislocation and facilitates early mobilization and enhanced functional recovery. This advancement proves vital in managing dislocations near critical structures like the trachea and blood vessels, where conventional methods may fall short. While the hook plate substantially enhances patient outcomes, hardware-related complications, such as plate breakage and fixation failure, underscore the imperative for ongoing plate design innovation and surgical technique enhancement. Overall, the sternoclavicular hook plate represents a significant enhancement in shoulder trauma surgery, offering continuous potential for refinement to mitigate complications and improve long-term success. The retrospective study design, small sample size, and restricted follow-up duration serve as notable limitations, limiting the generalizability of findings and complete assessment of long-term complications. To address these constraints, future research should encompass larger sample sizes, prospective studies, and extended follow-up periods to deepen understanding of the enduring efficacy of the plates. Recommending enhancements in implant design and surgical techniques is also key to minimizing risks and ensuring superior outcomes for SCJ dislocation patients. Conclusion This study affirms the effectiveness of sternoclavicular hook plates in stabilizing traumatic SCJ dislocations, particularly in instances requiring immediate mechanical stability, although concerns persist regarding hardware-related complications such as fixation failure and plate breakages. Future research endeavors should prioritize enhancing the durability of implants and conducting comprehensive, long-term studies to evaluate outcomes post-hardware removal. It is imperative to optimize patient selection, surgeon training, and personalized postoperative care to mitigate complications and improve long-term recovery. Declarations Ethics Approval and Consent to Participate: The study was approved by the Ethics Committee of Taizhou Hospital of Zhejiang Province of Ethics Committee (Approval Number: kL20240919). Informed consent was obtained from all participants prior to inclusion in the study. Consent for Publication: Written informed consent for publication of their clinical details and images was obtained from the parents or legal guardians of the patients. A copy of the consent form is available for review by the Editor of this journal. Competing Interests: The authors declare that they have no competing interests. Funding: This work was funded by the Enze Medical Center (Group) Scientific Research Fund (19EZC28, 21EZD21). Author Contribution Li Sheng designed the study. Jie Feng collected and analyzed the data. Xiaoyong Sheng contributed to the writing and editing of the manuscript. All authors read and approved the final manuscript. Acknowledgments: We would like to thank Taizhou Hospital of Zhejiang Province for their assistance and support in this study. Availability of Data and Materials: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. References Miniato MA, Anand P, Varacallo M. Anatomy, Shoulder and Upper Limb, Shoulder[J]2021. Kiel J, Ponnarasu S, Kaiser. K.,Sternoclavicular Joint Injury[J]2021,. Wang S, Chen Z, Lin L, et al. ,Long-term results for traumatic sternoclavicular joint dislocation treated with a sternoclavicular joint-specific plate[J]. ANZ J Surg. 2021;91(4):653–7. Tasnim S, Shirafkan A, Okereke I. Diagnosis and management of sternoclavicular joint infections: a literature review[J]. J Thorac Dis. 2020;12(8):4418–26. Lacheta L, Dekker TJ, Goldenberg BT, et al. ,Minimum 5-Year Clinical Outcomes, Survivorship, and Return to Sports After Hamstring Tendon Autograft Reconstruction for Sternoclavicular Joint Instability[J]. Am J Sports Med. 2020;48(4):939–46. Xin H, Wang X, Zhang S et al. ,Novel sternoclavicular hook plate for the treatment of posterior sternoclavicular dislocation: a retrospective study[J]. J Orthop Surg Res 2023,18(1):945. Qu YZ, Xia T, Liu GH et al. ,Treatment of Anterior Sternoclavicular Joint Dislocation with Acromioclavicular Joint Hook Plate[J].Orthop Surg,2019,11(1):91–6. Zhang C, Lin L, Liang J et al. Efficacy analysis of a novel sternoclavicular hook plate for treatment of unstable sternoclavicular joint dislocation or fracture[J].J Orthop Surg (Hong Kong),2017,25(1):2309499016684488. Gaines RJ, Liporace FA, Yoon RS, et al. ,A novel technique for ligamentous reconstruction of the sternoclavicular joint[J]. J Orthop Trauma. 2014;28(3):e65–69. Quayle JM, Arnander MW, Pennington RG, et al. ,Artificial ligament reconstruction of sternoclavicular joint instability: report of a novel surgical technique with early results[J]. Tech Hand Up Extrem Surg. 2014;18(1):31–5. Keohane D. Morrissey D.,Repair of sternoclavicular joint ligament: a novel approach[J]. Ir J Med Sci. 2022;191(5):2141–5. Adamcik S, Ahler M, Gioutsos K et al. ,Repair of sternoclavicular joint dislocations with FiberWire((R))[J].Arch Orthop Trauma Surg,2017,137(3):341–5. Zhang CY, Lin L, Liang JB, et al. ,[A new type sternoclavicular hook plate for unstable sternoclavicular joint dislocation and fracture][J]. Zhongguo Gu Shang. 2016;29(11):1040–4. Zhang Y, Xing B, Hou X, et al. ,A novel sternoclavicular hook plate for treatment of proximal clavicle fracture with dislocation of sternoclavicular join[J]. BMC Surg. 2022;22(1):250. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5319297","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":371628873,"identity":"e63c65f0-8f84-41b5-8284-0adb3e839ece","order_by":0,"name":"LI Sheng","email":"","orcid":"","institution":"Hangzhou First People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"LI","middleName":"","lastName":"Sheng","suffix":""},{"id":371628874,"identity":"e6ae11c8-d34c-4ef0-8be0-2e4a8476ab7f","order_by":1,"name":"Jie Jie","email":"","orcid":"","institution":"Hangzhou First People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Jie","suffix":""},{"id":371628875,"identity":"d87a1084-560d-4795-bc09-7f3d4a53b37d","order_by":2,"name":"Xiaoyong Sheng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYDACCQglB+UyE6/FmHQtiQ1Ea5Gf3Xzs4de2w+n90u0PH92osGbgb+9OwKvF4M6xdGOZM4dzZ845kGyccyadQeLM2Q34tUjkmElLVBzO3XAj4Zh0btthoEgufi3yM/K/SUsYHE63v5HY/jv3HxFaGG7ksEl+qDicYCCRzMac20CEFoMbaWbSDGfSDWfcSGOWzjmWzkPQL/Izkp9J/myzluefkf7wc06NtRx/ey8BhwEBMw9DM5zDQ1A5CDD+YKgjSuEoGAWjYBSMUAAAYqZHzJdCAPcAAAAASUVORK5CYII=","orcid":"","institution":"Zhejiang Taizhou Hospital","correspondingAuthor":true,"prefix":"","firstName":"Xiaoyong","middleName":"","lastName":"Sheng","suffix":""}],"badges":[],"createdAt":"2024-10-23 13:23:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5319297/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5319297/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":69249126,"identity":"6e575910-c9b2-4c88-affb-c8f038d45b2f","added_by":"auto","created_at":"2024-11-18 11:26:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":628100,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic illustration of the treatment of anterior dislocation of the \u0026nbsp;sternoclavicular joint in a 56-year-old man with a sternoclavicular hook plate. A) SCJ \u0026nbsp;plate and supporting tools, B) Surgery incision shape， C) Guide behind the sternum \u0026nbsp;and drill holes， D) SCJ plate passes through the sternum stem along the guidewire, E) \u0026nbsp;Plate fixes the SCJ， F) X-ray shows that the steel plate fixes the sternoclavicular joint\u003c/p\u003e","description":"","filename":"fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-5319297/v1/4332ca7b80c09cf241fc73a8.png"},{"id":69249509,"identity":"f108f2b7-54be-46b3-b9d9-b546aa67ab38","added_by":"auto","created_at":"2024-11-18 11:34:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":294537,"visible":true,"origin":"","legend":"\u003cp\u003e66-year-old male patient had internal fixation failure and re-dislocation. \u0026nbsp;A) X-ray of the SCJ fixation was loose on day 10 after surgery. B) X-ray of the re-operation image, C) CT 3D reconstruction of re-operation\u003c/p\u003e","description":"","filename":"fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-5319297/v1/7d821ce9e55d37ff24352ca2.png"},{"id":69249128,"identity":"0cbf1007-05fd-4466-b542-5125e10649ef","added_by":"auto","created_at":"2024-11-18 11:26:51","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":347083,"visible":true,"origin":"","legend":"\u003cp\u003eA 36-year-old male patient with a sternoclavicular hook plate utilized for \u0026nbsp;the treatment of anterior dislocation of the sternoclavicular joint experienced plate \u0026nbsp;breakage seven months post-surgery, with no subsequent reoccurrence of \u0026nbsp;sternoclavicular joint dislocation\u003c/p\u003e","description":"","filename":"fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-5319297/v1/bae44652fb730792ca91166a.png"},{"id":78568341,"identity":"241dcd87-32ec-4530-ac0e-f3974fe46e2c","added_by":"auto","created_at":"2025-03-15 08:01:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2094285,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5319297/v1/f58b3b38-8069-41d1-9917-19796c76350d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"complications and challenges of sternoclavicular hook plates for treating sternoclavicular joint dislocations","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSternoclavicular joint (SCJ) dislocations, although uncommon, pose significant challenges in trauma surgery due to the joint's crucial role in shoulder stability and its proximity to vital structures\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Dislocations are categorized as anterior, being more prevalent but less severe, or posterior, less common yet potentially life-threatening due to the risk of compression on the trachea, blood vessels, or esophagus\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Treatment options for SCJ dislocations vary from conservative approaches like closed reduction and immobilization for stable anterior dislocations to surgical interventions such as open reduction and internal fixation (ORIF) or ligament reconstruction for posterior dislocations or cases of persistent instability\u003csup\u003e[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe introduction of sternoclavicular hook plates has advanced the surgical approach by providing greater mechanical stability, particularly in traumatic cases, and allowing for early mobilization\u003csup\u003e[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Despite these benefits, the technique may be associated with complications like hardware failure, plate loosening, and functional impairments, underscoring the need for further procedural refinement and long-term outcome assessment. Consequently, there exists an urgent necessity for a thorough evaluation of the risks and advantages linked to the use of hook plates in treating SCJ dislocations.\u003c/p\u003e \u003cp\u003eThis study seeks to bridge this gap through an in-depth scrutiny of the inherent challenges and complications associated with this approach. The primary objective of this research is to systematically evaluate the frequency, types, and consequences of hardware and functional complications, as well as offer insights on optimizing surgical techniques and implant design to enhance patient outcomes.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Study Design\u003c/h2\u003e \u003cp\u003eThis retrospective cohort analysis involved 46 patients who underwent treatment with sternoclavicular hook plates for traumatic SCJ dislocations between 2015 and 2022 at our hospital. Inclusion criteria focused on patients with acute traumatic SCJ dislocations who had failed manual repositioning, re-dislocation after repositioning or could not tolerate prolonged joint immobilization, necessitating surgical intervention. Exclusion criteria included patients with chronic SCJ injuries, those managed conservatively, and individuals with underlying conditions impacting bone healing.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e1.2 Surgical Technique\u003c/h3\u003e\n\u003cp\u003eThe surgical procedure commenced with general anesthesia administration and patient positioning in the supine orientation. A unique inverted \"7\"-shaped incision was made along the upper midline of the sternum. The periosteum on the affected side of the sternum and the attachment of the sternocleidomastoid muscle were meticulously detached using a periosteal dissector. Subsequently, a drill guide mold was positioned at the sternum's midline, followed by drilling a 4.2mm hole perpendicular to the posterior wall. The sternum's thickness was gauged, and the hole was cleared of bone debris. The introducer cable was then tightened to insert the head-end guide wire into the sternal orifice. The steel plate trial head was inserted into the sternal hole from the posterior side after securing the nut to the guide mold with the \"T\" handle rotation. The sternoclavicular joint was reset by pulling the proximal clavicle and applying downward pressure. The appropriate sternum locking hook plate from Zhejiang CANWELL Medical Equipment Co. was selected based on the trial mold and measured thickness. The cable was tightened to insert the hook into the sternal orifice, and the plate was placed over the clavicle. Subsequent to drilling and tapping the clavicle, three screws were inserted, and joint stability was assessed. If instability persisted, a shim-like nut and lock nut were installed to secure the joint; otherwise, the cable nut was removed. The sternocleidomastoid muscle and sternoclavicular joint capsule were sutured with intermittent sutures to close the incision (Fig.\u0026nbsp;1).\u003c/p\u003e\n\u003ch3\u003e1.3 Postoperative Management:\u003c/h3\u003e\n\u003cp\u003eTwo weeks post-surgery, patients were fitted with a triangular shoulder sling, and gradual functional exercises were initiated. Restricted shoulder abduction and flexion within 90 degrees were advised for the initial one months, accompanied by avoidance of strenuous activities for a further three months. The sternoclavicular hook plate removal was generally recommended between 6 to 12 months post-surgery.\u003c/p\u003e\n\u003ch3\u003e1.4 Data Collection\u003c/h3\u003e\n\u003cp\u003eShoulder function and pain were measured pre and postoperatively utilizing the Constant Shoulder Score (CSS) and Visual Analog Scale (VAS), respectively. Radiographic imaging, including X-rays and CT scans, was utilized to monitor joint repositioning, evaluate hook plate placement accuracy, and assess hardware integrity throughout recovery. Intraoperative parameters, such as operative time, blood loss, and complications, were documented. Patients were closely monitored for an average of 26.7 months during postoperative follow-up through clinic visits or phone calls conducted at specific intervals.\u003c/p\u003e\n\u003ch3\u003e1.5 Statistical Analysis\u003c/h3\u003e\n\u003cp\u003eA comparative analysis between preoperative and postoperative outcomes using statistical tests like paired t-tests was conducted to assess changes in joint function and pain levels, contributing to a holistic evaluation of the effectiveness of hook plates in enhancing patient recovery.\u003c/p\u003e "},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.1 Patient Demographics and Clinical Data\u003c/h2\u003e \u003cp\u003eThe study cohort comprised 46 individuals who underwent treatment with sternoclavicular hook plates for SCJ dislocations between 2015 and 2022. The demographic analysis revealed a mean age of 49.3 years (range: 28 to 73 years), with a predominant representation of male patients (44 males, 2 females). High-energy trauma, primarily resulting from traffic accidents (44 cases) and sports injuries (2 cases), was the prevalent mechanism of injury. Notably, the breakdown of dislocation types indicated 42 cases of anterior dislocations and 4 cases of posterior dislocations. This categorization is significant given the increased risks associated with posterior dislocations, emphasizing the importance of utilizing hook plates in such scenarios.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003e2.2 Surgical Outcomes\u003c/h3\u003e\n\u003cp\u003eThe average operative duration for the 46 patients undergoing sternoclavicular hook plate fixation varied between 55 and 95 minutes, with a mean of 65.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4 minutes. Notably, there were no instances of nerve or vascular injuries reported as intraoperative complications, and the average blood loss during surgery was minimal at 46.2\u0026thinsp;\u0026plusmn;\u0026thinsp;14.6 mL. Preoperatively, the mean Constant Shoulder Score (CSS) was 36.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8 points (range: 28\u0026ndash;46 points). At the final follow-up, the postoperative mean CSS score significantly improved to 86.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2 points (range: 80\u0026ndash;92), p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, indicating a statistically significant difference. Moreover, the mean Visual Analog Scale (VAS) score demonstrated improvement from 7.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 (range: 5\u0026ndash;8) preoperatively to 1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4 (range: 0\u0026ndash;3) at the final follow-up, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, denoting a statistically significant difference. Radiographic assessments postoperatively, comprising X-rays and CT scans, consistently revealed successful joint repositioning across all cases, with the hook plates effectively maintaining proper sternoclavicular joint alignment. Throughout the follow-up period, hardware integrity remained intact with no instances of significant hardware loosening or displacement immediately post-surgery, although a few cases of hardware-related complications emerged during recovery.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Complications and Hardware Issues\u003c/h2\u003e \u003cp\u003eFollowing the utilization of sternoclavicular hook plates, the study identified several hardware-related complications. Notably, a 66-year-old male patient (2%) experienced fixation failure and redislocation within 10 days post-surgery, necessitating revision surgery (Fig.\u0026nbsp;2). Additionally, during follow-ups, plate breakages were noted in 4 patients (8.7%) (Fig.\u0026nbsp;3), although these occurrences did not lead to redislocation or immediate revision surgeries.\u003c/p\u003e \u003c/div\u003e "},{"header":"Discussion","content":"\u003cp\u003eThe study demonstrated successful joint repositioning in the majority of cases, as verified by postoperative radiographic evaluations. Most patients exhibited significant functional recovery, evidenced by improvements in the Constant Shoulder Score (CSS) and Visual Analog Scale (VAS) for pain, signifying effective shoulder function restoration. However, the study identified complications, including hardware failure in the form of plate breakages (8.7%) and one case (2%) of fixation failure resulting in redislocation. These hardware-related issues highlight a substantial risk associated with hook plate usage, particularly in older individuals with osteoporosis or those who are more physically active. Despite these challenges, most patients maintained joint stability and achieved positive functional outcomes postoperatively, although those experiencing hardware complications necessitated further interventions and had extended recovery periods. It emphasizes the necessity of closely monitoring hardware integrity and considering patient-specific characteristics to mitigate risks and enhance long-term results. While no instances of neurovascular injury were reported, hardware breakages did not mandate revision surgeries, prolong recovery, or significantly affect overall outcomes. These results underscore the balance between the mechanical stability provided by hook plates and the potential risks of hardware-related complications, especially in complex dislocations or high-demand patient populations.\u003c/p\u003e \u003cp\u003eComparison between sternoclavicular hook plates and other techniques, such as acromioclavicular (AC) hook plates and ligament repair (utilizing artificial or autologous ligaments), reveals distinct differences. Sternoclavicular hook plates offer immediate mechanical stability, enabling early mobilization and accelerated recovery in traumatic SCJ dislocations. Similarly, AC hook plates are commonly used for AC joint dislocations due to their robust fixation properties and ability to maintain reduction. Qu et al. \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e reported successful treatment of 10 patients with anterior SCJ dislocation using AC hook plates without complications, with a follow-up of 16.9 months, providing sufficient short-to-medium-term outcomes but lacking the long-term complications observed in this study. Ligament repair, whether with artificial or autologous grafts, adopts a more biological approach relying on the body's natural healing mechanisms. This method typically entails longer recovery periods due to the dependence on ligament healing and carries a heightened risk of redislocation in severe trauma cases compared to the immediate stabilization provided by hook plates. Nevertheless, ligament repair offers the advantage of avoiding hardware complications and may be preferable in less severe dislocations where the risk of hardware failure is unnecessary\u003csup\u003e[\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis study significantly contributes by addressing complications, challenges, and long-term outcomes associated with sternoclavicular (SC) hook plates in SCJ dislocation treatment, complementing the generally favorable outcomes reported in earlier studies\u003csup\u003e[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e, While past research indicated no complications, wound infections, or plate/screw breakages, this study highlights potential risks, providing a more comprehensive understanding of long-term performance and hardware-related complications in specific patient subsets. By uncovering this novel complication, absent in prior studies, this research underscores potential gaps in earlier evaluations, emphasizing the importance of comprehensive long-term monitoring and hardware performance analysis. This discovery suggests that previous studies may have underestimated certain risks over extended periods or in specific patient groups, enhancing clinical practice refinement through rigorous postoperative follow-up and surgical technique adaptation to proactively address future treatment challenges. Furthermore, this revelation underscores the ongoing need for plate design innovation and continued research to embrace the full spectrum of outcomes linked with sternoclavicular hook plates.\u003c/p\u003e \u003cp\u003eThe sternoclavicular hook plate has significantly advanced shoulder trauma surgery by delivering immediate mechanical stability for acute, traumatic dislocations. Its capacity to effectively realign the joint, particularly in intricate posterior dislocations, reduces the risk of redislocation and facilitates early mobilization and enhanced functional recovery. This advancement proves vital in managing dislocations near critical structures like the trachea and blood vessels, where conventional methods may fall short. While the hook plate substantially enhances patient outcomes, hardware-related complications, such as plate breakage and fixation failure, underscore the imperative for ongoing plate design innovation and surgical technique enhancement. Overall, the sternoclavicular hook plate represents a significant enhancement in shoulder trauma surgery, offering continuous potential for refinement to mitigate complications and improve long-term success.\u003c/p\u003e \u003cp\u003eThe retrospective study design, small sample size, and restricted follow-up duration serve as notable limitations, limiting the generalizability of findings and complete assessment of long-term complications. To address these constraints, future research should encompass larger sample sizes, prospective studies, and extended follow-up periods to deepen understanding of the enduring efficacy of the plates. Recommending enhancements in implant design and surgical techniques is also key to minimizing risks and ensuring superior outcomes for SCJ dislocation patients.\u003c/p\u003e \u003c/div\u003e "},{"header":"Conclusion","content":"\u003cp\u003eThis study affirms the effectiveness of sternoclavicular hook plates in stabilizing traumatic SCJ dislocations, particularly in instances requiring immediate mechanical stability, although concerns persist regarding hardware-related complications such as fixation failure and plate breakages. Future research endeavors should prioritize enhancing the durability of implants and conducting comprehensive, long-term studies to evaluate outcomes post-hardware removal. It is imperative to optimize patient selection, surgeon training, and personalized postoperative care to mitigate complications and improve long-term recovery.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics Approval and Consent to Participate:\u003c/strong\u003e \u003cp\u003e The study was approved by the Ethics Committee of Taizhou Hospital of Zhejiang Province of Ethics Committee (Approval Number: kL20240919). Informed consent was obtained from all participants prior to inclusion in the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for Publication:\u003c/strong\u003e \u003cp\u003e Written informed consent for publication of their clinical details and images was obtained from the parents or legal guardians of the patients. A copy of the consent form is available for review by the Editor of this journal.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting Interests:\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis work was funded by the Enze Medical Center (Group) Scientific Research Fund (19EZC28, 21EZD21).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLi Sheng designed the study. Jie Feng collected and analyzed the data. Xiaoyong Sheng contributed to the writing and editing of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments:\u003c/h2\u003e \u003cp\u003eWe would like to thank Taizhou Hospital of Zhejiang Province for their assistance and support in this study.\u003c/p\u003e\u003ch2\u003eAvailability of Data and Materials:\u003c/h2\u003e \u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMiniato MA, Anand P, Varacallo M. Anatomy, Shoulder and Upper Limb, Shoulder[J]2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKiel J, Ponnarasu S, Kaiser. K.,Sternoclavicular Joint Injury[J]2021,.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang S, Chen Z, Lin L, et al. ,Long-term results for traumatic sternoclavicular joint dislocation treated with a sternoclavicular joint-specific plate[J]. ANZ J Surg. 2021;91(4):653\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTasnim S, Shirafkan A, Okereke I. Diagnosis and management of sternoclavicular joint infections: a literature review[J]. J Thorac Dis. 2020;12(8):4418\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLacheta L, Dekker TJ, Goldenberg BT, et al. ,Minimum 5-Year Clinical Outcomes, Survivorship, and Return to Sports After Hamstring Tendon Autograft Reconstruction for Sternoclavicular Joint Instability[J]. Am J Sports Med. 2020;48(4):939\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXin H, Wang X, Zhang S et al. ,Novel sternoclavicular hook plate for the treatment of posterior sternoclavicular dislocation: a retrospective study[J]. J Orthop Surg Res 2023,18(1):945.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQu YZ, Xia T, Liu GH et al. ,Treatment of Anterior Sternoclavicular Joint Dislocation with Acromioclavicular Joint Hook Plate[J].Orthop Surg,2019,11(1):91\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang C, Lin L, Liang J et al. Efficacy analysis of a novel sternoclavicular hook plate for treatment of unstable sternoclavicular joint dislocation or fracture[J].J Orthop Surg (Hong Kong),2017,25(1):2309499016684488.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGaines RJ, Liporace FA, Yoon RS, et al. ,A novel technique for ligamentous reconstruction of the sternoclavicular joint[J]. J Orthop Trauma. 2014;28(3):e65\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuayle JM, Arnander MW, Pennington RG, et al. ,Artificial ligament reconstruction of sternoclavicular joint instability: report of a novel surgical technique with early results[J]. Tech Hand Up Extrem Surg. 2014;18(1):31\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeohane D. Morrissey D.,Repair of sternoclavicular joint ligament: a novel approach[J]. Ir J Med Sci. 2022;191(5):2141\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdamcik S, Ahler M, Gioutsos K et al. ,Repair of sternoclavicular joint dislocations with FiberWire((R))[J].Arch Orthop Trauma Surg,2017,137(3):341\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang CY, Lin L, Liang JB, et al. ,[A new type sternoclavicular hook plate for unstable sternoclavicular joint dislocation and fracture][J]. Zhongguo Gu Shang. 2016;29(11):1040\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Xing B, Hou X, et al. ,A novel sternoclavicular hook plate for treatment of proximal clavicle fracture with dislocation of sternoclavicular join[J]. BMC Surg. 2022;22(1):250.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Sternoclavicular Hook, SCJ Dislocation, Hardware Failure, Joint Stabilization, Postoperative Outcomes","lastPublishedDoi":"10.21203/rs.3.rs-5319297/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5319297/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eobjective\u003c/h2\u003e \u003cp\u003eThis study aims to evaluate the efficacy and complications associated with the use of sternoclavicular hook plates for the treatment of traumatic sternoclavicular joint (SCJ) dislocations.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study retrospectively analyzed the use of sternoclavicular (SC) hook plates for treating sternoclavicular joint (SCJ) dislocations, with a particular focus on identifying hardware-related complications such as plate breakages and fixation failures. A cohort of patients who underwent SC hook plate fixation was evaluated based on clinical outcomes, functional recovery, and the occurrence of complications. Data collection included postoperative imaging (X-rays and CT scans) to assess joint repositioning and hardware integrity, as well as functional assessments using the Constant Shoulder Score (CSS) and Visual Analog Scale (VAS) for pain.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe utilization of hook plates led to successful joint stabilization and notable functional enhancement, as evidenced by the mean CSS scores increasing from 36.4 preoperatively to 86.6 postoperatively, and VAS scores decreasing from 7.2 to 1.6. However, 4 patients (8.7%) experienced plate breakages with no redislocation, and 1 patient (2%) encountered fixation failure necessitating revision surgeries. No major neurovascular complications were reported.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eDespite providing effective stabilization for SCJ dislocations, sternoclavicular hook plates are associated with hardware-related issues, including plate breakages and fixation failures. Enhancements in implant design, surgical procedures, and patient selection are imperative in mitigating these concerns and enhancing long-term outcomes. Future research should prioritize the development of more robust implants and exploration of alternative treatment modalities.\u003c/p\u003e","manuscriptTitle":"complications and challenges of sternoclavicular hook plates for treating sternoclavicular joint dislocations","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-18 11:26:47","doi":"10.21203/rs.3.rs-5319297/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"310f66ba-9d23-4263-81f1-5fd0a2d0736f","owner":[],"postedDate":"November 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-15T07:53:36+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-18 11:26:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5319297","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5319297","identity":"rs-5319297","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}