Associated thoracic injury in patients with a clavicle fracture: a retrospective analysis of 1461 polytrauma patients

Laarhoven, J.J.E.M. van; Hietbrink, Falco; Ferree, Steven; Gunning, Amy C.; Houwert, Roderick M.; Verleisdonk, Egbert-Jan M. M.; Leenen, Luke P. H.

doi:10.1007/s00068-016-0673-6

Cited by 31 publications

(24 citation statements)

References 16 publications

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“…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 (18). Although there is no difference in the distribution of medial clavicle fractures between monotrauma and polytrauma patients (19), the dislocation of sternoclavicular joint is often associated of a high force by trauma mechanism (20).…”

Section: Discussionmentioning

confidence: 99%

Injuries of the Medial Clavicle: A Cohort Analysis in a Level-I-Trauma-Center. Concomitant Injuries. Management. Classification

Bakır¹,

Merschin²,

Unterkofler³

et al. 2017

chr

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Introducere: Deşi leziunile la nivelul umărului sunt frecvente, cele ale claviculei mediane sunt prea puţin explorate. O clasificare aplicată este mai puţin utilizată ca management standard. Metode: O analiză retrospectivă a leziunilor claviculare medii (MCI) pe parcursul unui stagiu de tratament de 5 ani într-un Centru de Traumatologie de nivel 1. Am analizat, printre altele, leziunile concomitente, strategiile de terapie şi clasificarea conform standardelor AO. Rezultate: 19 (2,5%) din 759 de leziuni claviculare au fost mediale (11 fracturi de tip A, 6 B şi 2 C), dintre care 27,8% au fost deplasate şi drept urmare tratate chirurgical. Osteosinteza cu placă fixă a fost utilizată în fracturi instabile şi reconstrucţia ligamentelor în articulaţia sternoclaviculară (SCJ) în cazul întreruperii acestora. 84,2% dintre pacienţi au prezentat leziuni concomitente relevante. Numeroase fracturi de mediane au fost codificate greşit ca fracturi mediale, ceea ce a limitat populaţia de studiu Concluzii: MCI a rezultat din mecanisme de vătămare cu impact puternic, adesea cu dislocare semnificativă şi leziuni concomitente. În ceea ce priveşte complexitatea leziunilor mediale, tratamentul ar trebui efectuat în spitale specializate. Fracturile instabile şi leziunile ligamentelor SCJ trebuie luate în considerare pentru tratamentul chirurgical. Fracturile mediane ar trebui să se

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Section: Discussionmentioning

confidence: 99%

Injuries of the Medial Clavicle: A Cohort Analysis in a Level-I-Trauma-Center. Concomitant Injuries. Management. Classification

Bakır¹,

Merschin²,

Unterkofler³

et al. 2017

chr

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“…A Dutch working group investigated a rather large collective and showed a higher risc of lung injuries and chest wall deformities concomitant to an additional CF in FCI (6). The Clavicle therefore had been named as a gatekeeper of the thorax.…”

Section: Introductionmentioning

confidence: 99%

Surgical Stabilization of Costoclavicular Injuries - A Combination of Flail Chest Injuries and a Clavicula Fracture

Langenbach¹,

Pinther²,

Krinner³

et al. 2017

chr

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RezumatDate generale: Leziunile cu volet costal (FCI) sunt asociate cu o rată ridicată de morbiditate şi mortalitate. Având în vedere că asocierea unei fracturi de claviculă concomitente cu FCI agravează chiar rezultatul, întrebarea care se pune este cum pot fi aceste leziuni costoclaviculare (CCI) gestionate chirurgical. Metode: 11 pacienţi cu CCI au fost trataţi chirurgical prin osteosinteză a claviculei şi a coastelor subiacente prin placă blocată, prin abordări chirurgicale limitate, sub anestezie generală. Pacienţii au fost urmăriţi la 2, 6, 12, 26 şi 52 de săptămâni. Rezultate: Toţi pacienţii au prezentat o deformare severă a peretelui toracic din cauza fracturilor puternic deplasate ale coastelor şi claviculei. Ei sufereau de durere şi de restrângerea mişcărilor respiratorii. Peretele toracic a putut fi restabilit la forma normală în toate cazurile, cu vindecare lipsită de complicaţii a oaselor şi confort sporit al pacientului. Fracturile claviculei şi celei de-a doua coaste au fost gestionate printr-o abordare inovatoare clavipectorală, iar celelalte prin abordări standard ale peretelui anterolateral şi posterolateral. Doi pacienţi s-au plâns de amorţeală în zona intervenţiei laterale şi de durere periscapulară peristentă. Concluzii: Stabilizarea chirurgicală ar putea reprezenta terapia adecvată în CCI cu fracturi dislocate, deoarece acestea ar putea cauza deformări severe şi pierderea funcţiei peretelui toracic şi a umărului.

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“…Basic characteristics of our study cohort correspond to other studies describing the epidemiology of clavicle fractures in thoracic trauma, like the Dutch National Trauma Database [11] or a British collective from Leeds [28]. In these populations patients were also predominantly male and had a mean age of 39.1 and 47.5 years, respectively.…”

Section: Discussionmentioning

confidence: 52%

“…In multiply-injured patients sustaining a clavicle fracture concomitant thoracic injuries occur in 77% [9]. Therefore, the clavicle can be considered the gatekeeper of the thorax [10,11].…”

Section: Introductionmentioning

confidence: 99%

Surgical Stabilization of Clavicle Fractures Reduces Organ Failure Rates in Multiply-injured Patients with Thoracic Trauma: An Analysis Based on the TraumaRegister DGU®.

Eberbach

Lefering

Hager³

et al. 2020

Preprint

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Introduction: Thoracic trauma has decisive influence on the outcome of multiply-injured patients and is often associated with clavicle fractures. The affected patients are prone to lung dysfunction and multiple organ failure. The aim of this study is to investigate the influence of surgical stabilization of clavicle fractures in patients with thoracic trauma on specific outcome parameters.Methods: A multi-center, retrospective analysis of patient records documented in the TraumaRegister DGU® between 2009 and 2015 was performed. The inclusion criteria were multiply-injured patients with thoracic trauma and associated clavicle fracture, maximum AIS severity ≥ 3 and admission to the intensive care unit. The influence of operative vs. non-operative clavicular fracture treatment and timing of surgery on lung failure, multiple organ failure, sepsis, length of ICU stay, intubation time and length of hospital stay was assessed by regression analysis.Results: A total of 3,209 patients were included in the analysis. In 1,362 patients (42%) the clavicle fracture was treated operatively after 7.1 ± 5.3 days. Surgically treated patients had a significant reduction in lung failure (p = 0.013, OR = 0.74), multiple organ failure (p = 0.001, OR = 0.64), intubation time (p = 0.004; -1.81 days) and length of hospital stay (p = 0.014; -1.51 days) compared to non-operative treatment. Moreover, surgical fixation of the clavicle within five days following hospital admission significantly reduced the rates of lung failure (p = 0.01, OR = 0.62), multiple organ failure (p = 0.01, OR = 0.59) and length of hospital stay (p = 0.01; -2.1 days).Conclusions: Based on our results, multiply-injured patients with thoracic trauma and concomitant clavicle fracture seem to benefit significantly from surgical stabilization of a clavicle fracture, especially when surgery is performed within the first five days after hospital admission.

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Associated thoracic injury in patients with a clavicle fracture: a retrospective analysis of 1461 polytrauma patients

Abstract: 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.

Cited by 31 publications

References 16 publications

Injuries of the Medial Clavicle: A Cohort Analysis in a Level-I-Trauma-Center. Concomitant Injuries. Management. Classification

Injuries of the Medial Clavicle: A Cohort Analysis in a Level-I-Trauma-Center. Concomitant Injuries. Management. Classification

Surgical Stabilization of Costoclavicular Injuries - A Combination of Flail Chest Injuries and a Clavicula Fracture

Surgical Stabilization of Clavicle Fractures Reduces Organ Failure Rates in Multiply-injured Patients with Thoracic Trauma: An Analysis Based on the TraumaRegister DGU®.

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