The clavicle can be seen as the gatekeeper of the thorax. In polytrauma patients, a clavicle fracture is easily diagnosed during primary survey and may indicate underlying thoracic injury, as the rate and extent of concomitant thoracic injury are high.
BackgroundAlthough extensive research for the optimal treatment of clavicle fractures has been performed, comparative studies between monotrauma and polytrauma patients are lacking.ObjectiveTo compare fracture distribution and treatment in monotrauma and polytrauma patients with a clavicle fracture.MethodsSingle center retrospective cohort study. Fractures were classified by the Robinson classification. Monotrauma patients sustained only a clavicle fracture or a clavicle fracture plus a minor abrasion, hematoma, or superficial skin lesion leading to an Injury Severity Score (ISS) of 4 or 5 respectively. Polytrauma patients had an ISS ≥16 as a result of injury in 2 or more Abbreviated Injury Scale (AIS) regions.Results154 monotrauma and 155 polytrauma patients with a clavicle fracture were identified. Monotrauma patients had a higher incidence of Type IIB fractures (displaced midshaft) compared to polytrauma patients (P = 0.002). No difference was observed regarding Type I (medial) and Type III (lateral) fractures. In monotrauma patients, Type IIB fractures were treated operatively more frequently (P = 0.004). The initial treatment for Type I and Type III fractures did not differ between monotrauma and polytrauma patients.ConclusionsMonotrauma patients had a higher incidence of displaced midshaft clavicle fractures compared to polytrauma patients, and monotrauma patients with displaced midshaft clavicle fractures were treated operatively more frequently. No differences were found in the distribution and treatment of medial and lateral clavicle fractures.
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