Medizinische Universität Graz - Research portal
Selected Publication:
Kotzor, EA.
Medical diagnosis and treatment of sternoclavicular empyema
A retrospective analysis
[ Diplomarbeit ] Medical University of Graz; 2012. pp. 102
[OPEN ACCESS]
FullText
- Authors Med Uni Graz:
- Advisor:
- Schintler Michael
- Altmetrics:
- Abstract:
- We retrospectively studied and analysed medical records of eight patients who were treated for sternoclavicular joint infections during the past ten years at the Medical Universitiy of Graz, Austria. Our results classify a diagnosis and therapy design, which from our point of view, is the best management of sternococlavicular joint infections, regarding minor complications, best functional and cosmetic outcome. Sternoclavicular joint infections are rare and reported with about 0,5% - 1% of all joint infections. However an abscess is present in 20% of all cases. The infection occurs in correlation with different risk factors like intravenous drug abuse, diabetes, HIV, hepatitis C, oncologic surgery, radiotherapy and central line placement. The infection is mainly caused by an invasion of the sternoclavicular joint with pathogens resulting in osteomyelitis, septic arthritis, necrosis and joint destruction. The spreading of pathogens into the sternoclavicular joint can occur directly through the skin, by ascending or descending regional infections or through the blood stream. Clinical diagnosis is provided by anamnesis, inflammatory signs and symptoms like rubor, calor, tumor, dolor and functio laesa, an increased CRP and by imaging like a CT scan or a MRI. Bacterial swabs taken by joint puncture or during surgery certify diagnosis, while bacterial cultures allow targeted antimicrobial therapy. The intraarticular located focus, resulting in septic arthritis with osteomyelitis, necrosis and local destruction needs aggressive surgical approach. Optimal therapy resulting in best clinical, functional and cosmetic outcome consists of four therapeutic steps. 1. Targeted intravenous antibiotics. 2. An aggressive surgical debridement with resection of the sternoclavicular joint, the sternal part of the clavicle, half of the manubrium and the first costal cartilage. 3. Negative wound pressure therapy. 4. Local reconstruction with an ipsilateral pectoralis major advancement flap. A two ore more stage surgical procedure is essential for infection control and to avoid recurrence of infection.