Muscle flaps for sternoclavicular joint septic arthritis

Septic arthritis of the sternoclavicular joint (SC) is rare. The most accepted technique for reconstruction of the defect after SC joint resection is the use of muscle flaps. We hypothesized that resection of ribs with the SC joint impacts timing, type and outcomes of reconstruction. This is a retrospective review of 44 patients who underwent wound closure with muscle flap following resection of the SC joint for septic arthritis over 14 years period from a single institution. Patients were divided into two groups based on the resection of the adjacent ribs with the SC joint. We found 18 (40.9%) patients with SC joint resection only and 26 (59.1%) with concomitant resection of the adjacent ribs. Patients in the rib resection group were younger, did not need SC joint fluid aspiration, and had higher tissue culture positivity (p < .05). Rib resection with the SC joint was found to be associated with delayed reconstruction (57.7% vs 22.2%, p = .030), need for serial debridement's (2 vs 1, p = .009), increased days from debridement to reconstruction for a subset of patients (75% percentile of 8 days vs. 0 days, p = .024), and longer hospital stay (18 vs 9, p = .006). Flap complications were higher in rib resection group (26.9% vs 5.6%, p = .67). Reconstruction following resection of the SC joint for septic arthritis is guided by the surgeon's impression regarding source control of infection. Rib resection concomitantly with joint resection appears to be a useful indicator of disease extent and may help guide clinical decision making in this challenging scenario.