A 33-year-old man presented to ER following a skiing accident, reporting a trauma to lower cervical spine. Clinical examination revealed tenderness in the anterior chest. The past medical history was unremarkable.
An anteroposterior radiograph of the chest was performed (Fig. 1), showing no alterations. The lateral radiograph (Fig. 2), focused on the point of tenderness, revealed a type II manubriosternal joint dislocation.
Traumatic manubriosternal joint dislocation is a rare and potentially serious injury; it can be associated with concurrent injuries to ribs, lungs, or myocardium [1]. We can distinguish two kind of manubriosternal dislocation, depending on the position of the sternum in relation to the manubrium: in type I dislocation, the body of the sternum is displaced in a dorsal direction; in type II dislocation, the sternal body is displaced on the ventral side of the manubrium. Direct or indirect traumatic events may cause manubriosternal dislocation: direct injuries generally result from a road accident collision, and they may evolve in either a type I or a type II dislocation; an indirect trauma always leads to a type II dislocation, due to a spine flexion-compression mechanism. An isolated manubriosternal dislocation is unusual because the flexion-compression mechanism is usually associated with vertebral fractures [2].
A plain radiograph centred on the sternum in lateral view is fundamental to achieve a diagnosis [3]. CT can be indicated in exceptional cases, in particular when the patient showed signs of thoracic compression.
Treatment of this condition is problematic: non-operative management after reduction is associated with a considerable rate of subluxations or reluxations, especially due to weak patient compliance. Moreover these disorders can lead to chronic pain, periarticular calcification with ankylosis, and progressive deformity [4]. Whenever the dislocation is associated with instability, pain or respiratory distress, the surgical fixation should be considered.
Type II manubriosternal dislocation
Based on the patient’s anteroposterior and lateral chest X-ray examination, the following features can be observed:
1. On the lateral X-ray view, there is noticeable misalignment between the manubrium and the sternal body, with evident displacement; the arrow indicates anterior (or posterior) malposition of the sternal body, consistent with imaging findings of manubriosternal joint dislocation.
2. The anteroposterior view is mainly utilized to exclude obvious lung parenchymal lesions or rib fractures. Clear lung fields and no definitive signs of rib fracture are noted.
3. There is no clear evidence of pneumothorax or hemothorax, but given the nature of the trauma, it is important to remain alert to potential intrathoracic organ injuries.
Combining the patient’s trauma history and imaging findings, the following are the main considerations for diagnosis or differential diagnosis:
Combining the imaging finding of misalignment of the manubriosternal joint on the lateral view, the mechanism of injury, and local palpation tenderness, the most likely diagnosis is: “Manubriosternal Joint Dislocation (possibly Type II).”
According to existing literature and clinical experience, the following measures can be taken for treating manubriosternal joint dislocation:
Rehabilitation/Exercise Prescription (FITT-VP Principle):
Please closely observe the patient’s pain levels and cardiopulmonary function during exercise, especially early in rehabilitation. If there is significant pain, chest tightness, palpitations, or other discomfort, seek medical attention promptly or reduce exercise intensity.
This report is a reference-based analysis derived from available imaging and information, and does not replace in-person consultation or direct professional medical advice. If you have any questions or if the condition changes, please consult a specialist or visit a reputable medical institution promptly.
Type II manubriosternal dislocation
