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

Abstract

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

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

“…Due to the clavicle’s function as a connection between the upper extremity and the thorax, it is not surprising that injuries to the adjacent joints have, in particular, concomitant injuries in these proximate regions of the body. 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 .…”

“…This finding is most likely due to SCJ injuries. Sternal concomitant injuries in addition to neurovascular injuries at dorsal dislocations of the SCJ have been described, particularly in the case of higher-grade lesions of the SCJ 13 , which highlights the complexity of higher-grade SCJ injuries 2 , 3 , 28 , 29 .…”

“…The question of whether clavicular joint injuries (CJI) show similar relationships, which are analogous to CFs, has not been answered yet. Some case reports/case studies indicate such analogies exist 3 , 12 . Particularly, in the case of dorsal SCJ dislocation, the anatomical proximity can lead to severe concomitant injuries to neurovascular structures in the area between the thorax and the arms.…”

“…As secondary endpoints, we expect the trauma mechanism to be stronger than in the control group 7 . We assume that in addition to the increased Injury Severity Score (ISS), this trauma could also have a negative impact on the outcome as represented by the length of stay in the intensive care unit (ICU) and in the hospital 3 . Since the CJIs mostly do not represent life-threatening injuries, and deaths are extremely rare, we do not expect any relevant difference in mortality 16 .…”

Medial injuries of the clavicle: more prevalent than expected? A big data analysis of incidence, age, and gender distribution based on nationwide routine data

“…n number of patients mean age as in a Swedish study concerning clavicle fractures [9,12]. The age pattern was also similar with less deviation of a peak in old age over 80 years in a previous clinical study, which included only a small number of cases (n = 19) [12]. The present data are based on a larger sample, so the results might be considered more representative.…”