Epidemiology of combined clavicle and rib fractures: a systematic review

Sweet, Arthur A. R.; Beks, Reinier B.; IJpma, Frank F. A.; Jong, Mirjam B. de; Beeres, Frank J. P.; Leenen, Luke P. H.; Houwert, Roderick M.; Baal, Mark C.P.M. van

doi:10.1007/s00068-021-01701-4

Cited by 6 publications

(12 citation statements)

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“…Quality of life was similar between the nonoperative and operative group after 6 weeks (EQ5D-5L, 0.77 ± 0.2 vs. 0.70 ± 0.2; p = 0.135) and 1 year (EQ5D-5L, 0.84 ± 0.2 vs. 0.82 ± 0.2; p = 0.658) (Table 3). There were no differences in pain between nonoperative and operative treatment after 3 days (median, 3 [2][3][4]…”

Section: Secondary Outcomesmentioning

confidence: 96%

“…Thoracic injuries are common, occurring as both isolated chest injuries and multiple injuries in patients 1,2 . In multiple injury patients who sustained blunt chest trauma, the most prevalent fractures include rib (86%), clavicle fractures (19%), or a combination of these injuries (19%) 3,4 . Both injuries are considered indicators of the severity of thoracic trauma and may independently increase the risk of mortality 5–9 .…”

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confidence: 99%

“…Therefore, patients with these combined injuries after blunt thorax trauma seem prone to (respiratory) complications and longer hospitalization 10,11 . There is an ongoing debate whether fixation of the clavicle fracture in patients with multiple concomitant rib fractures could be beneficial to provide additional stability to the chest wall and thereby improve clinical outcomes 4 …”

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confidence: 99%

“…1,2 In multiple injury patients who sustained blunt chest trauma, the most prevalent fractures include rib (86%), clavicle fractures (19%), or a combination of these injuries (19%). 3,4 Both injuries are considered indicators of the severity of thoracic trauma and may independently increase the risk of mortality. [5][6][7][8][9] The combination of multiple rib and clavicle fractures could result in decreased stability, compliance, and respiratory support of the chest wall.…”

mentioning

confidence: 99%

“…10,11 There is an ongoing debate whether fixation of the clavicle fracture in patients with multiple concomitant rib fractures could be beneficial to provide additional stability to the chest wall and thereby improve clinical outcomes. 4 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.…”

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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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Section: Secondary Outcomesmentioning

confidence: 96%

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confidence: 99%

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confidence: 99%

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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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Clavicle fixation to reduce short-term analgesia and improve respiratory function in patients with chest wall injuries

Franco

Williamson

Manzanero

et al. 2023

Arch Orthop Trauma Surg

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Introduction The objective of this study was to determine if operative fixation of clavicle fractures in patients with non-operatively treated ipsilateral rib fractures is associated with a lower overall analgesic requirement and improved respiratory function. Materials and methods A retrospective matched cohort study was conducted involving patients admitted to a single tertiary trauma centre having sustained a clavicle fracture with ipsilateral rib fracture/s between January 2014 and June 2020. Patients were excluded if brain, abdominal, pelvic, or lower limb trauma was identified. 31 patients with operative clavicle fixation (study group) were matched 1:1 to 31 patients with non-operative management of the clavicle fracture (control group) based on age, sex, number of rib fractures and injury severity score. The primary outcome was the number of analgesic types used, and the secondary outcome was respiratory function. Results The study group required a mean of 3.50 types of analgesia prior to surgery which decreased to 1.57 post-surgery. The control group required 2.92 types of analgesia, reducing to 1.65 after the date of surgery in the study group. A General Linear Mixed Model indicated that the intervention (operative vs. non-operative management) had statistically significant effects on the number of required analgesic types (p < 0.001, $$\eta_{{\text{p}}}^{2}$$ η p 2 = 0.365), oxygen saturation (p = 0.001, $$\eta_{{\text{p}}}^{2}$$ η p 2 = 0.341, 95% CI 0.153–0.529) and temporal decline in daily supplemental oxygen requirement (p < 0.001, $$\eta_{{\text{p}}}^{2}$$ η p 2 = 0.626, 95% CI 0.455–0.756). Conclusion This study supported the hypothesis that operative clavicle fixation reduces short-term in-patient analgesia use and improves respiratory parameters in patients with ipsilateral rib fractures. Level of evidence Level III therapeutic study.

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Comparison of Infectious Complications after Surgical Fixation versus Epidural Analgesia for Acute Rib Fractures

Kheirbek

Martin

Cao

et al. 2022

Surgical Infections

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Epidemiology of combined clavicle and rib fractures: a systematic review

Cited by 6 publications

References 40 publications

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

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

Clavicle fixation to reduce short-term analgesia and improve respiratory function in patients with chest wall injuries

Comparison of Infectious Complications after Surgical Fixation versus Epidural Analgesia for Acute Rib Fractures

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