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Successful Manubriosternal Fusion Following Failure of Open Reduction and Internal Fixation of a Traumatic Manubriosternal DislocationA Case Report
Aaron T. Scott, MD1; Jason J. Halvorson, MD2; Tadhg J. O’Gara, MD1; Adrian L. Lata, MD1
1 Department of Orthopaedic Surgery (A.T.S., T.J.O.), Department of Cardiothoracic Surgery (A.L.L.), Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157. E-mail address for A.T. Scott: aascott@wakehealth.edu. E-mail address for T.J. O’Gara: togara@wakehealth.edu. E-mail address for A.L. Lata: alata@wakehealth.edu
2 Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address: jhalvorsnd@gmail.com
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Investigation performed at Wake Forest University School of Medicine, Winston-Salem, North Carolina

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Oct 09;3(4):e98 1-5. doi: 10.2106/JBJS.CC.M.00071
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Manubriosternal joint dislocations are rare clinical entities that may occur secondary to trauma1-4, inflammatory arthropathy5-7, or infection8. When they occur in a traumatic setting, concomitant cardiac contusions, pulmonary contusions, and spine fractures or dislocations may be observed9,10, and they must be treated appropriately. Manubriosternal dislocations may be classified as type-1 injuries, in which the sternal body is dislocated posteriorly with respect to the manubrium, or as type-2 injuries, in which the sternal body is dislocated anteriorly11. It is felt that most posterior dislocations are the result of direct impact to the anterior chest wall, while anterior dislocations are uniformly the result of an indirect flexion-compression mechanism12. Both operative1-4 and nonoperative8,10,11,13 strategies have been employed, but because of the relative rarity of this injury, a consensus regarding optimal management has not been established.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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