Acute clavicle fixation after blunt chest trauma: effect on pulmonary outcomes and patient disposition

Graf, Adam; Wendler, Derrick; Court, Tannor; Talhelm, Jacob; Carver, Thomas; Beck, Chad; Schmeling, Gregory J

doi:10.1007/s00590-022-03368-y

Cited by 1 publication

(9 citation statements)

References 27 publications

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“…10 All patients underwent operative treatment for both injuries during the same session, which resulted in a mean ± SD HLOS of 18.8 ± 8.1 days. This is considerably higher compared with our study (median HLOS, 9 [5][6][7][8][9][10][11][12][13][14][15][16][17] days), which could be explained by differences in study population regarding the number of flail chests. However, their study would not be able to assess whether clavicula fixation would improve clinical outcome because of the small sample size and the noncomparative study design.…”

Section: Discussioncontrasting

confidence: 84%

“…They found no differences in HLOS and other in-hospital outcomes, which resembles our findings. Our study adds to their results, because we corrected for confounding factors by using PS matching and they did not 13 . One prospective case series reported on HLOS in 11 patients with combined rib and clavicle fractures following blunt chest trauma 10 .…”

Section: Discussionmentioning

confidence: 97%

“…This study was performed in six level 1 trauma centers between January 2018 and March 2021. The study protocol and results on operative versus nonoperative treatment of multiple rib fractures have been published 13,14 …”

Section: Methodsmentioning

confidence: 99%

“…The study protocol and results on operative versus nonoperative treatment of multiple rib fractures have been published. 13,14 In the current study, we focus solely on patients with rib fractures in combination with a clavicle fracture. All consecutive patients of 18 years and older with computed tomography confirmed that multiple rib fractures (defined as three or more ipsilateral rib fractures) combined with an ipsilateral clavicle fracture were eligible for inclusion.…”

Section: Methodsmentioning

confidence: 99%

“…Despite the vast amount of literature describing rib fractures and clavicle fractures as individual entities, the mutual impact and subsequent management of these combined injuries remain unclear. So far, only three studies reported on treatment outcomes in patients with both clavicle and rib fractures 12,13 . Graf et al 13 reported on a chart review of 60 patients with blunt chest trauma and concomitant clavicle fractures, and they did not find any differences between early clavicle fixation versus nonoperative treatment of clavicle fractures.…”

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confidence: 99%

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In patients with combined clavicle and multiple rib fractures, does fracture fixation of the clavicle improve clinical outcomes? A multicenter prospective cohort study of 232 patients

Hoepelman¹,

Linde²,

Beeres

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND Clavicle and rib fractures are often sustained concomitantly. The combination of injuries may result in decreased stability of the chest wall, making these patients prone to (respiratory) complications and prolonged hospitalization. This study aimed to assess whether adding chest wall stability by performing clavicle fixation improves clinical outcomes in patients with concurrent clavicle and rib fractures. METHODS A prospective multicenter study was performed including all adult patients admitted between January 2018 and March 2021 with concurrent ipsilateral clavicle and rib fractures. Patients treated operatively versus nonoperatively for their clavicle fracture were matched using propensity score matching. The primary outcome was hospital length of stay (HLOS). Secondary outcomes were intensive care unit length of stay, duration of mechanical ventilation, pain, complications, and quality of life at 6 weeks and 12 months of follow-up. RESULTS In total, 232 patients with concomitant ipsilateral clavicle and rib fractures were included. Fifty-two patients (22%) underwent operative treatment of which 39 could be adequately matched to 39 nonoperatively treated patients. No association was observed between clavicle plate fixation and HLOS (mean difference, 2.3 days; 95% confidence interval, −2.1 to 6.8; p = 0.301) or any secondary endpoint. Eight of the 180 nonoperatively treated patients (4%) had a symptomatic nonunion, for which 5 underwent secondary clavicle fixation. CONCLUSION We found no evidence that, in patients with combined clavicle and multiple rib fractures, plate fixation of the clavicle reduces HLOS, pain, or (pulmonary) complications, nor that it improves quality of life. STUDY TYPE Therapeutic/Care Management; Level III.

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