Introduction: Sternoclavicular joint infections (SCJIs) are extremely rare, making up less than 1% of all septic arthritis cases. This retrospective study aims to evaluate the management and outcomes of SCJIs, including both surgical and non-surgical approaches. Methods: This retrospective study included 55 patients treated between January 2005 and December 2023 at the Division of Thoracic and Hyperbaric Surgery in Graz, Austria. Data on patient characteristics, treatment approach, and outcome were analyzed. Results: Out of the 55 patients, 50 (90.91%) underwent surgery. Among them, 21 (38.18%) had pleural involvement and 9 (16.36%) developed sepsis. Primary debridement and sternoclavicular joint resection with muscle flap closure were performed in 5 patients (9.3%), whilst debridement and negative pressure wound therapy (NPWT) followed by joint resection were applied in 32 patients (59.3%). In total, 15 (27.2%) of these cases required a secondary muscle flap. Positive cultures were found in 35 patients (63.64%), with Staphylococcus aureus being the most common pathogen. Multivariate analysis identified elevated CRP and leukocyte levels as significant predictors of sepsis. Defects requiring myoplastic procedures were associated with a higher risk of complications, sepsis, and prolonged hospital stays. Postoperative complications occurred in 20 patients (36.36%), but there was no 30-day mortality. Conclusions: SCJI is a rare but serious condition that requires prompt surgical intervention. Our findings suggest that combining surgical resection with NPWT and/or myocutaneous flap techniques is effective. Close monitoring of inflammatory markers is crucial for identifying sepsis risk and improving patient outcomes.