{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T15:11:37Z","timestamp":1788966697346,"version":"build-2803163510"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To evaluate pediatric and adolescent patients with posterior sternoclavicular (SC) joint dislocations, identify the prevalence of missed diagnoses at initial presentation, and determine injury features that may aid in earlier recognition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We retrospectively reviewed patients presenting to our institution with CT-confirmed posterior SC joint dislocations between October 2015 and November 2024. Anterior dislocations, subluxations, and cases without confirmatory imaging were excluded. Demographics, injury characteristics, diagnosis timelines, management, and outcomes were recorded and analyzed using descriptive statistics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Thirty-six patients (median age 14.9 years, IQR 13.8 to 16.6; 91.7% male) sustained posterior SC dislocations. Thirteen (36.1%) were missed at initial presentation, with delays up to 19 days (median 7, IQR 2 to 13). Missed cases occurred in both emergency (10\/30, 33.3%) and outpatient (3\/6, 50.0%) settings, with similar rates in those with (9\/25, 36.0%) and without (4\/11, 36.4%) clavicle fractures. Injuries most often resulted from a lateral shoulder blow (28\/36, 77.8%), and 83.3% of patients with documented forward flexion had pain-limited motion. Most injuries (86.1%) were sports-related. Nearly all (97.2%) underwent surgical fixation without complications, and 77.4% with follow-up returned to sports.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Over one-third of posterior SC joint dislocations were initially missed, with similar rates in patients with and without an associated clavicle fracture. These injuries are most often seen in the emergency department, typically from contact sports and a lateral blow to the shoulder. Given the risk of neurovascular injury, timely diagnosis is critical. Clinicians should maintain a high index of suspicion in patients with anterior chest pain after a lateral shoulder impact and when full forward flexion is pain-limited. Prompt recognition, CT imaging, and early orthopedic consultation are critical to ensure proper management and optimal outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/pec.0000000000003602","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T11:00:51Z","timestamp":1775127651000},"page":"583-587","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Posterior Sternoclavicular Joint Dislocations in Children and Adolescents"],"prefix":"10.1097","volume":"42","author":[{"given":"Sean P.","family":"Owens","sequence":"first","affiliation":[{"name":"Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew F.","family":"Grady","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Surgery, The Children\u2019s Hospital of Philadelphia, Philadelphia"},{"name":"Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"R1-20260909","doi-asserted-by":"crossref","first-page":"2517","DOI":"10.1177\/0363546514523386","article-title":"Posterior sternoclavicular joint injuries in the adolescent population: a meta-analysis","volume":"42","author":"Tepolt","year":"2014","journal-title":"Am J Sports Med"},{"key":"R2-20260909","doi-asserted-by":"crossref","first-page":"e251","DOI":"10.1097\/BOT.0000000000001463","article-title":"Sternoclavicular joint dislocation: a systematic review and meta-analysis","volume":"33","author":"Sernandez","year":"2019","journal-title":"J Orthop Trauma"},{"key":"R3-20260909","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1302\/0301-620X.92B1.22186","article-title":"Posterior dislocation of the sternoclavicular joint and epiphyseal disruption of the medial clavicle with posterior displacement in sports participants","volume":"92","author":"Laffosse","year":"2010","journal-title":"J Bone Joint Surg Br"},{"key":"R4-20260909","first-page":"e49916","article-title":"Management of posterior sternoclavicular joint dislocation in a teenager after a direct elbow strike to his clavicle: a case report","volume":"15","author":"Gurcinar","year":"2023","journal-title":"Cureus"},{"key":"R5-20260909","doi-asserted-by":"crossref","first-page":"5428","DOI":"10.3390\/jcm13185428","article-title":"Management options for traumatic posterior sternoclavicular joint dislocation: a narrative review with a single institution\u2019s experience","volume":"13","author":"Ciatti","year":"2024","journal-title":"J Clin Med"},{"key":"R6-20260909","doi-asserted-by":"crossref","first-page":"148","DOI":"10.5435\/JAAOS-D-20-01239","article-title":"Acute dislocations of the sternoclavicular joint: a review article","volume":"30","author":"Obremskey","year":"2022","journal-title":"J Am Acad Orthop Surg"},{"key":"R7-20260909","doi-asserted-by":"crossref","first-page":"e319","DOI":"10.1097\/JSM.0000000000000878","article-title":"Successful nonsurgical management of a posteriorly displaced medial clavicular physeal fracture in an adolescent athlete: a case report","volume":"32","author":"Wagner","year":"2022","journal-title":"Clin J Sport Med"},{"key":"R8-20260909","doi-asserted-by":"crossref","first-page":"e19.00074","DOI":"10.2106\/JBJS.ST.19.00074","article-title":"Open reduction and suture fixation of acute sternoclavicular fracture-dislocations in children","volume":"10","author":"Swarup","year":"2020","journal-title":"JBJS Essent Surg Tech"},{"key":"R9-20260909","doi-asserted-by":"crossref","first-page":"e0244209","DOI":"10.1371\/journal.pone.0244209","article-title":"Dislocations of the acromioclavicular and sternoclavicular joint in children and adolescents: a retrospective clinical study and big data analysis of routine data","volume":"15","author":"Kraus","year":"2020","journal-title":"PLoS One"},{"key":"R10-20260909","first-page":"201","article-title":"Posterior sternoclavicular dislocations--a diagnosis easily missed","volume":"81","author":"Thomas","year":"1999","journal-title":"Ann R Coll Surg Engl"},{"key":"R11-20260909","doi-asserted-by":"crossref","first-page":"427","DOI":"10.5312\/wjo.v14.i6.427","article-title":"Incidence of sports-related sternoclavicular joint dislocations in the United States over the last two decades","volume":"14","author":"Sandler","year":"2023","journal-title":"World J Orthop"},{"key":"R12-20260909","doi-asserted-by":"crossref","first-page":"e2","DOI":"10.2106\/JBJS.RVW.17.00157","article-title":"Clinical outcomes and complications following surgical management of traumatic posterior sternoclavicular joint dislocations","volume":"6","author":"Kendal","year":"2018","journal-title":"JBJS Reviews"},{"key":"R13-20260909","doi-asserted-by":"crossref","first-page":"e1076","DOI":"10.5435\/JAAOS-D-19-00611","article-title":"Sternoclavicular joint instability and reconstruction","volume":"30","author":"Provencher","year":"2022","journal-title":"J Am Acad Orthop Surg"},{"key":"R14-20260909","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1097\/BPO.0000000000000114","article-title":"Posterior sternoclavicular joint injuries in skeletally immature patients","volume":"34","author":"Lee","year":"2014","journal-title":"J Pediatr Orthop"},{"key":"R15-20260909","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1007\/s00256-016-2399-2","article-title":"Posterior sternoclavicular Salter-Harris fracture-dislocation in a patient with unossified medial clavicle epiphysis","volume":"45","author":"Beckmann","year":"2016","journal-title":"Skeletal Radiol"},{"key":"R16-20260909","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1097\/BPO.0000000000000148","article-title":"Chronic posterior sternoclavicular joint fracture dislocations in children and young adults: results of surgical management","volume":"34","author":"Ting","year":"2014","journal-title":"J Pediatr Orthop"},{"key":"R17-20260909","doi-asserted-by":"crossref","first-page":"3076","DOI":"10.1177\/03635465221131900","article-title":"Return to sports after closed reduction of acute traumatic posterior sternoclavicular joint dislocations: a systematic review","volume":"51","author":"Damschen","year":"2023","journal-title":"Am J Sports Med"}],"container-title":["Pediatric Emergency 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