{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T03:37:30Z","timestamp":1777865850384,"version":"3.51.4"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Berufsgenossenschaftliches Klinikum Bergmannsheil gGmbH"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Biological augmentation is necessary in chronic sternoclavicular dislocations. However, the placement of drill holes for a graft can be difficult at that region. The aim of this study was to evaluate, as an early proof-of-concept, the feasibility of using a locally available clavicular periosteal flap (CPF) or sternal periosteal flap (SPF) for sternoclavicular joint (SCJ) stabilization and to biomechanically test the periosteal flaps.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cadaveric anatomic feasibility and biomechanical study (level of evidence V) was performed on nine SCJs. The CPF was mobilized from three sides by lifting the flap off the bone, preserving its attachment near the SCJ. Two 1.6\u00a0mm drill holes were created in the sternum, and the CPF was folded over the SCJ and fixed with a non-resorbable wire. Additionally, the non-resorbable wire was used in terms of a figure-of-8-bracing through a 1.6\u00a0mm clavicular drill hole to secure the joint position. Flap dimensions and sternal overlap were measured. Vice versa SPFs were prepared in selected specimens and fixed in a similar fashion. The CPFs were biomechanically tested using a uniaxial tensile testing machine to obtain values for stress at 50% strain (\u03c3 (50%)), maximum force (Fmax), maximum stress (\u03c3max), strain at maximum force (\u03b5(Fmax)), and strain at failure (\u03b5 at failure).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      CPF mobilization and fixation were successfully achieved in all specimens. The flaps showed an average length and width of 3.5\u2009\u00d7\u20092.6\u00a0cm and a sternal overlap of 2.0\u00a0cm. In four specimens, sternal periosteal flaps (SPF) were additionally mobilized, with an average length and width of 3.0\u2009\u00d7\u20092.6\u00a0cm and a clavicular overlap of 2.1\u00a0cm. Both flap types demonstrated adequate size for sufficient joint overlapping. Biomechanical testing of the CPFs yielded a mean stress at 50% strain (\u03c3 (50%)) of 0.30\u2009\u00b1\u20090.12\u00a0N\/mm\n                      <jats:sup>2<\/jats:sup>\n                      , a maximum force (Fmax) of 18.55\u2009\u00b1\u20099.0\u00a0N, a maximum stress (\u03c3max) of 0.48\u2009\u00b1\u20090.10\u00a0N\/mm\n                      <jats:sup>2<\/jats:sup>\n                      , a strain at maximum force (\u03b5(Fmax)) of 1.69\u2009\u00b1\u20090.82%, and a strain at failure (\u03b5 at failure) of 2.36\u2009\u00b1\u20091.41%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This cadaveric study provides an early proof-of-concept demonstrating the feasibility of a novel SCJ stabilization technique using a locally available CPF or SPF. While this approach may offer advantages by minimizing donor-site morbidity associated with graft harvesting and potentially reducing surgical complexity, further biomechanical and clinical studies are required to establish its effectiveness and clinical applicability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>V.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00068-026-03194-5","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T07:34:17Z","timestamp":1777534457000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessment of a new technique for biological augmentation in sternoclavicular joint dislocations: a cadaveric feasibility and biomechanical evaluation"],"prefix":"10.1007","volume":"52","author":[{"given":"Ole","family":"Somberg","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eckart","family":"F\u00f6rster","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Rosteius","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Bernstorff","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Schildhauer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"K\u00f6nigshausen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"3194_CR1","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1067\/mse.2002.119394","volume":"11","author":"EE Spencer","year":"2002","unstructured":"Spencer EE, Kuhn JE, Huston LJ, Carpenter JE, Hughes RE. Ligamentous restraints to anterior and posterior translation of the sternoclavicular joint. J Shoulder Elb Surg. 2002;11:43\u20137.","journal-title":"J Shoulder Elb Surg"},{"key":"3194_CR2","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1177\/1758573218756880","volume":"10","author":"R Dhawan","year":"2018","unstructured":"Dhawan R, Singh RA, Tins B, Hay SM. Sternoclavicular joint. Shoulder Elb. 2018;10:296\u2013305.","journal-title":"Shoulder Elb"},{"key":"3194_CR3","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1016\/S0278-5919(02)00104-7","volume":"22","author":"KJ Renfree","year":"2003","unstructured":"Renfree KJ, Wright TW. Anatomy and biomechanics of the acromioclavicular and sternoclavicular joints. Clin Sports Med. 2003;22:219\u201337.","journal-title":"Clin Sports Med"},{"key":"3194_CR4","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1007\/s00113-011-2148-x","volume":"116","author":"M Dudda","year":"2013","unstructured":"Dudda M, Kruppa C, Schildhauer TA. [Post-traumatic bipolar dislocation of the clavicle: is operative treatment reasonable?]. Unfallchirurg. 2013;116:176\u20139.","journal-title":"Unfallchirurg"},{"key":"3194_CR5","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/S0020-1383(73)80016-6","volume":"5","author":"JC Mehta","year":"1973","unstructured":"Mehta JC, Sachdev A, Collins JJ. Retrosternal dislocation of the clavicle. Injury. 1973;5:79\u201383.","journal-title":"Injury"},{"key":"3194_CR6","doi-asserted-by":"publisher","first-page":"268","DOI":"10.5435\/00124635-199609000-00005","volume":"4","author":"MA Wirth","year":"1996","unstructured":"Wirth MA, Rockwood CA Jr. Acute and Chronic Traumatic Injuries of the Sternoclavicular Joint. J Am Acad Orthop Surg. 1996;4:268\u201378.","journal-title":"J Am Acad Orthop Surg"},{"key":"3194_CR7","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1097\/00005373-196803000-00004","volume":"8","author":"JL Nettles","year":"1968","unstructured":"Nettles JL, Linscheid RL. Sternoclavicular dislocations. J Trauma. 1968;8:158\u201364.","journal-title":"J Trauma"},{"key":"3194_CR8","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1016\/S0278-5919(02)00112-6","volume":"22","author":"J Bicos","year":"2003","unstructured":"Bicos J, Nicholson GP. Treatment and results of sternoclavicular joint injuries. Clin Sports Med. 2003;22:359\u201370.","journal-title":"Clin Sports Med"},{"key":"3194_CR9","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1177\/03635465241299426","volume":"53","author":"M Hinz","year":"2025","unstructured":"Hinz M, Kopolovich D, Kanakamedala AC, Davis C, Horan MP, Drumm A, Rupp MC, Provencher MT, Millett PJ. Minimum 10-Year Clinical and Functional Outcomes, and Return to Sport After Sternoclavicular Joint Reconstruction for Sternoclavicular Joint Instability. Am J Sports Med. 2025;53:33\u20138.","journal-title":"Am J Sports Med"},{"key":"3194_CR10","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1177\/0363546519900896","volume":"48","author":"L Lacheta","year":"2020","unstructured":"Lacheta L, Dekker TJ, Goldenberg BT, Horan MP, Rosenberg SI, Pogorzelski J, Millett PJ. Minimum 5-Year Clinical Outcomes, Survivorship, and Return to Sports After Hamstring Tendon Autograft Reconstruction for Sternoclavicular Joint Instability. Am J Sports Med. 2020;48:939\u201346.","journal-title":"Am J Sports Med"},{"key":"3194_CR11","doi-asserted-by":"crossref","unstructured":"El Zouhbi A, Hammad A, Hammad M, Nassereddine M. Anterior sternoclavicular joint dislocation classification and management: a review of the literature. JBJS Rev. 2025;13.","DOI":"10.2106\/JBJS.RVW.25.00011"},{"key":"3194_CR12","doi-asserted-by":"publisher","first-page":"232596711878371","DOI":"10.1177\/2325967118783717","volume":"6","author":"G Tytherleigh-Strong","year":"2018","unstructured":"Tytherleigh-Strong G, Pecheva M, Titchener A. Treatment of First-Time Traumatic Anterior Dislocation of the Sternoclavicular Joint With Surgical Repair of the Anterior Capsule Augmented With Internal Bracing. Orthop J Sports Med. 2018;6:2325967118783717.","journal-title":"Orthop J Sports Med"},{"key":"3194_CR13","doi-asserted-by":"publisher","first-page":"3635","DOI":"10.1177\/03635465221124267","volume":"50","author":"G Tytherleigh-Strong","year":"2022","unstructured":"Tytherleigh-Strong G, Sabharwal S, Peryt A. Clinical Outcomes and Return to Sports After Open Reduction and Hamstring Tendon Autograft Reconstruction in Patients With Acute Traumatic First-Time Posterior Dislocation of the Sternoclavicular Joint. Am J Sports Med. 2022;50:3635\u201342.","journal-title":"Am J Sports Med"},{"key":"3194_CR14","doi-asserted-by":"crossref","unstructured":"Ciatti C, Masoni V, Maniscalco P, Asti C, Puma Pagliarello C, Caggiari G, Pes M, Rivera F, Quattrini F. Management options for traumatic posterior sternoclavicular joint dislocation: a narrative review with a single institution\u2019s experience. J Clin Med. 2024;13.","DOI":"10.3390\/jcm13185428"},{"key":"3194_CR15","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1177\/1758573218790964","volume":"12","author":"MA Imam","year":"2020","unstructured":"Imam MA, Javed S, Trail I, Monga P. The unicortical sternoclavicular joint reconstruction using synthetic graft. Shoulder Elb. 2020;12:144\u20137.","journal-title":"Shoulder Elb"},{"key":"3194_CR16","first-page":"128","volume":"69","author":"D Thut","year":"2011","unstructured":"Thut D, Hergan D, Dukas A, Day M, Sherman OH. Sternoclavicular joint reconstruction\u2013a systematic review. Bull NYU Hosp Jt Dis. 2011;69:128\u201335.","journal-title":"Bull NYU Hosp Jt Dis"},{"key":"3194_CR17","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1097\/00005131-199012000-00010","volume":"4","author":"KP de Jong","year":"1990","unstructured":"de Jong KP, Sukul DM. Anterior sternoclavicular dislocation: a long-term follow-up study. J Orthop Trauma. 1990;4:420\u20133.","journal-title":"J Orthop Trauma"},{"key":"3194_CR18","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1016\/j.jse.2005.07.005","volume":"15","author":"Z Abiddin","year":"2006","unstructured":"Abiddin Z, Sinopidis C, Grocock CJ, Yin Q, Frostick SP. Suture anchors for treatment of sternoclavicular joint instability. J Shoulder Elb Surg. 2006;15:315\u20138.","journal-title":"J Shoulder Elb Surg"},{"key":"3194_CR19","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1016\/S1058-2746(02)86802-1","volume":"12","author":"WM Franck","year":"2003","unstructured":"Franck WM, Jannasch O, Siassi M, Hennig FF. Balser plate stabilization: an alternate therapy for traumatic sternoclavicular instability. J Shoulder Elb Surg. 2003;12:276\u201381.","journal-title":"J Shoulder Elb Surg"},{"key":"3194_CR20","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1186\/s13018-023-04436-7","volume":"18","author":"H Xin","year":"2023","unstructured":"Xin H, Wang X, Zhang S, Lin L, Chen H, Hong H. Novel sternoclavicular hook plate for the treatment of posterior sternoclavicular dislocation: a retrospective study. J Orthop Surg Res. 2023;18:945.","journal-title":"J Orthop Surg Res"},{"key":"3194_CR21","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.jse.2012.02.009","volume":"22","author":"G Singer","year":"2013","unstructured":"Singer G, Ferlic P, Kraus T, Eberl R. Reconstruction of the sternoclavicular joint in active patients with the figure-of-eight technique using hamstrings. J Shoulder Elb Surg. 2013;22:64\u20139.","journal-title":"J Shoulder Elb Surg"},{"key":"3194_CR22","doi-asserted-by":"publisher","first-page":"98","DOI":"10.2106\/00004623-200401000-00015","volume":"86","author":"EE Spencer Jr","year":"2004","unstructured":"Spencer EE Jr., Kuhn JE. Biomechanical analysis of reconstructions for sternoclavicular joint instability. J Bone Joint Surg Am. 2004;86:98\u2013105.","journal-title":"J Bone Joint Surg Am"},{"key":"3194_CR23","doi-asserted-by":"crossref","unstructured":"Qiu XS, Wang XB, Zhang Y, Zhu YC, Guo X, Chen YX. Anatomical study of the clavicles in a Chinese population. Biomed Res Int. 2016;2016:6219761.","DOI":"10.1155\/2016\/6219761"},{"key":"3194_CR24","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/j.jse.2015.08.004","volume":"25","author":"M Petri","year":"2016","unstructured":"Petri M, Greenspoon JA, Horan MP, Martetschl\u00e4ger F, Warth RJ, Millett PJ. Clinical outcomes after autograft reconstruction for sternoclavicular joint instability. J Shoulder Elb Surg. 2016;25:435\u201341.","journal-title":"J Shoulder Elb Surg"},{"key":"3194_CR25","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1016\/j.rbo.2014.08.013","volume":"50","author":"VB de Padua","year":"2015","unstructured":"de Padua VB, Nascimento PE, Silva SC, de Gusm\u00e3o Canuto SM, Zuppi GN, de Carvalho SM. Saphenous nerve injury during harvesting of one or two hamstring tendons for anterior cruciate ligament reconstruction. Rev Bras Ortop. 2015;50:546\u20139.","journal-title":"Rev Bras Ortop"},{"key":"3194_CR26","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1016\/j.arthro.2006.06.019","volume":"22","author":"A Almaz\u00e1n","year":"2006","unstructured":"Almaz\u00e1n A, Miguel A, Odor A, Ibarra JC. Intraoperative incidents and complications in primary arthroscopic anterior cruciate ligament reconstruction. Arthroscopy. 2006;22:1211\u20137.","journal-title":"Arthroscopy"},{"key":"3194_CR27","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1055\/s-2008-1038338","volume":"29","author":"J Kjaergaard","year":"2008","unstructured":"Kjaergaard J, Faun\u00f8 LZ, Faun\u00f8 P. Sensibility loss after ACL reconstruction with hamstring graft. Int J Sports Med. 2008;29:507\u201311.","journal-title":"Int J Sports Med"},{"key":"3194_CR28","doi-asserted-by":"crossref","unstructured":"Dzidzishvili L, Dave U, Rubin J, Madden DJ, Bi AS, Cavaignac E, Chahla J. Autograft anterior cruciate ligament reconstruction results in improved graft synovial coverage and stability, while remnant-preserving techniques further enhance synovialization: A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2025.","DOI":"10.1002\/ksa.70052"},{"key":"3194_CR29","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1007\/s00256-009-0849-9","volume":"39","author":"JR Dwek","year":"2010","unstructured":"Dwek JR. The periosteum: what is it, where is it, and what mimics it in its absence? Skeletal Radiol. 2010;39:319\u201323.","journal-title":"Skeletal Radiol"},{"key":"3194_CR30","first-page":"e76774","volume":"17","author":"P Panagakis","year":"2025","unstructured":"Panagakis P, Zygogiannis K, Fanourgiakis I, Kalatzis D, Stathopoulos K. The Role of the Periosteum in Bone Formation From Adolescence to Old Age. Cureus. 2025;17:e76774.","journal-title":"Cureus"}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-026-03194-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-026-03194-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-026-03194-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T07:34:24Z","timestamp":1777534464000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00068-026-03194-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3194"],"URL":"https:\/\/doi.org\/10.1007\/s00068-026-03194-5","relation":{},"ISSN":["1863-9941"],"issn-type":[{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]},"assertion":[{"value":"28 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval was obtained from the local Ethics Committee (2024-591-f-S).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"155"}}