The objective of this study was to evaluate the efficacy of various treatment options for sternoclavicular joint osteomyelitis. We evaluated patients with a diagnosis of sternoclavicular joint osteomyelitis, treated at our hospital from 2002 to 2012. Four treatment options were compared. Three out of twelve patients were successfully cured with antibiotics alone (25%). Debridement with or without negative pressure therapy was successful for one of three patients (33%). Simultaneous debridement, bone resection, and muscle flap coverage of the acquired defect successfully treated one of two patients (50%). Debridement with delayed bone resection and muscle flap coverage was successful in five of five patients (100%). Osteomyelitis of the sternoclavicular joint is a rare disease that has become more prevalent in recent years and can be associated with increasing use of long-term indwelling catheters. Initial debridement with delayed bone resection and pectoralis major muscle flap coverage can effectively treat sternoclavicular joint osteomyelitis. 1. Introduction Sternoclavicular joint (SCJ) osteomyelitis is an infection of the joint where the clavicle attaches to the manubrium and is usually associated with an abscess in the area. It is a very rare condition with approximately 225 cases reported in the past 45 years [1–21]. All of the patients reported in the literature were treated with antibiotics initially and some patients underwent surgical management of sternoclavicular joint osteomyelitis when symptoms did not improve on antibiotics. Previously described surgical techniques include simple incision with debridement and drainage with or without negative pressure dressing [2, 3, 22–24], resection of the sternoclavicular joint with healing by secondary intention [3, 25], and resection with simultaneous flap coverage using pectoralis major, latissimus dorsi, or rectus abdominus muscles [2, 22–24, 26]. Patients who underwent simple incision with debridement and drainage either have prolonged open wound care with median of 12 weeks [2] or a high failure rate up to 80% [23]. Patients who underwent resection with immediate pectoralis major muscle flap had wound complication rates up to 50% [2]. Our experience in treating this condition and evaluating limitations of previously described techniques for management of sternoclavicular joint osteomyelitis has led to the development of a novel surgical strategy for treatment. We propose initial incision and debridement of the infected sternoclavicular joint followed by delayed resection and pectoralis major
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