Medical and conservative surgical management of bacterial sternoclavicular joint septic arthritis: a case series

Background Sternoclavicular joint septic arthritis (SCJ SA) is a rare infectious disease process with reported life-threatening complications such as mediastinal abscess and mediastinitis. The available literature reports variable success of medical management and a predominance of surgical management, with a 58% rate of surgical washout/debridement and high rates (47%) of resection of the SCJ and medial third of the clavicle. Methods A retrospective case series of radiologically or microbiologically confirmed cases of bacterial SCJ SA at Fiona Stanley Hospital was analysed. Demographic data, investigations, management and outcomes were assessed. Results Eleven cases of bacterial SCJ SA were identified. Eight cases were of primary SCJ SA, whilst three cases were secondary to haematogenous seeding. Recognized risk factors such as intravenous drug use, diabetes mellitus, trauma, smoking and immunosuppression were present. The most common complication was clavicular osteomyelitis (64%). Life-threatening complications included mediastinal abscess and rapidly progressive necrotizing myositis. Nine patients (82%) were managed with primary medical therapy, with two patients failing antibiotic therapy and requiring joint washout. Two patients were taken for urgent washout on presentation. Four cases (36%) resulted in operative SCJ washout. There were no cases requiring resection of the SCJ or clavicle. Conclusion This series suggests that SCJ SA can be primarily treated medically in the absence of life-threatening complications. In addition, medical management may be sufficient for cases complicated by clavicular osteomyelitis. Need for surgical resection of the SCJ and medial third of the clavicle may be less than previously reported.