Distribution and treatment of clavicular fractures in monotrauma and polytrauma patients

Abstract

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.

Acromioclavicular and sternoclavicular joint dislocations indicate severe concomitant thoracic and upper extremity injuries in severely injured patients

“…Depending on individual circumstances, a severely injured and therefore, for some reason, inoperable patient might lead to the choice of a more conservative treatment despite a general indication for surgery. This finding coincides with results concerning CF cases, which were treated surgically four times as often in monotrauma compared to polytrauma patients 10 . The fact that increasing numbers of operations are performed with increasing injury severity is entirely plausible since low-grade CJIs are usually no indication for surgery 35 , 39 .…”

“…This is consistent with previous analyses 2 , 3 . This relationship was also shown in preliminary work on the CF, which we were able to confirm as well as that for CJI 2 , 6 , 8 , 10 . Severe thoracic injuries have often been detected in the past in patients with medial clavicle injuries such as SCJ dislocations 2 Hence the denotation of the clavicle as the gatekeeper of the thorax is accurate 11 .…”

“…Since the impact of the frequently occurring clavicle fractures (CF) in severely injured patients has been thoroughly investigated, minimal data are available on the comparatively rare injuries of the sternoclavicular and acromioclavicular joints (SCJ and ACJ, respectively) 2 – 9 . CFs are known as indicators of further injuries (thoracic and upper extremity injuries) in severely injured patients and are associated with an increased overall injury severity 6 , 8 and have been described in an analysis of data from the TraumaRegister DGU (TR-DGU) 6 , 8 , 10 . Therefore, the clavicle can be described as a kind of “gatekeeper of the thorax” 11 .…”

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

“…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). There is also a higher rate of severe co-injuries in our patients with medial clavicular injuries in comparison to patients with any shoulder girdle injury in general (20) regarding the head (medial 36,8% vs. overall 31.5%) and thoracic injury (medial 52.6% vs. overall 36.8%) (Fig.…”

“…3). In case of a dislocation of the SCJ with rupture of the costoclavicular ligament (CCL), an open reduction 19 showed anterior SCJ luxation without any fracture which is known as type Allmann III. Considering the concomitant injuries of the SCJ and its ligaments SCL and CCL in fractures of the medial clavicle one alternative classification showed a different distribution of the severity of the cases (6 A, 9 B, 4 C).…”