Demographics of the injury pattern in severely injured patients with an associated clavicle fracture: a retrospective observational cohort study

Abstract

BackgroundDespite an increasing interest in the treatment of clavicle fractures, this is still a not yet defined area in severely injured patients as most studies exclude these patients. Analyzing fracture type and evaluate accompanying injuries can provide valuable information in an early stage of trauma care.ObjectiveTo identify prevalence, fracture type and accompanying injuries of clavicle fractures in the severely injured patient.MethodsWe included all severely injured patients (ISS ≥ 16) with a clavicle fracture from January 2007 - December 2011. We prospectively collected data about demographics, injuries, trauma mechanism and mortality. Fractures were classified using the Robinson classification.ResultsA total of 1534 patients had an ISS ≥16, of which 164 (10.7%) patients had a clavicle fracture. Traffic related accidents were the main cause of injury (65%). Most fractures were midshaft fractures (66.5%) of which 56% were displaced. Seven patients were treated operatively. There was no significant difference in ISS between the three fracture types. 83% of the patients sustained additional injury to the head and neck; the most prevalent injuries were skull or skull base fractures (41.5%) and maxillofacial fractures (29%). Furthermore 77% of the patients had additional thoracic injury; the most prevalent injuries were rib fractures (59%) and a pneumothorax (38%). The mortality rate was 21.4%.ConclusionA clavicle fracture was present in more than 10% of the severely injured patients. Displaced midshaft clavicle fractures were the most common type of fracture. Additional injuries to the head and neck region occurred in 83% of the patients and thoracic injuries occurred in 77% of the patients.

Cutaneous paresthesia after internal plate fixation of clavicle fractures and underlying anatomical observations

“…The increasing incidence of clavicle fractures has led to increases in the rates of clavicle nerve injury, numbness, and pain after open reduction and internal fixation. [ 15 , 16 ] However, the prognosis of patients with numbness after surgery remains to be clarified.…”

Missed clavicle fractures on anterior-posterior views of skull X-rays: a retrospective, observational, and descriptive study

“…Given the high prevalence of skull fractures, skull APs are taken more frequently than clavicle X-rays. Van Laarhoven et al [ 12 ] reported that a skull fracture is the most commonly associated injury in severely injured patients with clavicle fractures. Thus, physicians should maintain a high index of suspicion for clavicle fractures when they read a skull AP because of the frequency with which skull APs are performed and the association between skull and clavicle fractures.…”

Epidemiology of combined clavicle and rib fractures: a systematic review

“…Blunt thoracic trauma contributes to complications and mortality as it may directly injure vital thoracic and abdominal structures secured by the chest wall, but also secondarily by impairing the chest wall integrity [3][4][5][6]. Both clavicle fractures and rib fractures have been shown to act as a marker of severity of the chest injury and have both independently been shown to increase the risk of mortality [7][8][9][10][11]. A combination of clavicle and rib fractures may further worsen the outcome.…”

“…However, several recent studies have shown benefits of operative treatment of multiple displaced rib fractures and flail chest injuries, compared to conservative treatment [16][17][18][19]. More than 10% of polytrauma patients suffer from a clavicle fracture, with 77% of those also sustaining other thoracic injuries [9]. Treatment of isolated clavicle fractures primarily depends on the location, displacement, and degree of comminution of the fracture [20,21].…”