Injuries of the sternoclavicular region indicate concomitant lesions and need distinguished imaging

Helfen, Tobias; Jansen, Stephan; Fleischhacker, Evi; Böcker, Wolfgang; Wirth, Stéfan; Ockert, Ben

doi:10.1007/s00068-019-01178-2

Cited by 6 publications

(7 citation statements)

References 14 publications

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“…The confession of a limited validity can also be underlined by the low proportion of injuries caused by transport vehicle accidents. This differs distinctly from previous work in which the proportion of this trauma mechanism is more than 60% [ 12 , 26 , 27 ]. Presumably, one reason for this underrepresentation is that the V99 coding for motor vehicle accident is merely an additional coding and not a necessity, but only a supplement [ 17 ].…”

Section: Discussioncontrasting

confidence: 99%

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

Bakır

Unterkofler

Haralambiev

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Although shoulder-girdle injuries occur frequently, injuries of the medial part remain widely unexplored. This study overviews these rare injuries with a focus on incidence, age, and sex distribution in Germany. Methods The data are based on diagnoses according to ICD-10 in all German hospitals provided by the German Federal Statistical Office. ICD-10 codes S42.01 (medial clavicle fracture, MCF) and S43.2 (sternoclavicular joint dislocation, SCJD) were evaluated in detail between 2012 and 2014. Results We identified 14,264 cases with medial clavicle injuries (MCIs). MCFs occurred more often (11.6% of all claviclerelated shoulder-girdle injuries vs. 0.6% for SCJD). Mean ages of MCI were significantly different between males (43.7 years) and females (57.1 years) (p < 0.01). Age demonstrated a bimodal distribution with peaks at 20 and 50 years, which were predominantly associated with males. Females showed more injuries at age beyond 70 years. This applies to both SCJD and MCF. The incidence rate of these shoulder-girdle injuries was 47.0 per 100,000 person-years, for MCIs overall 5.9 (4.1 for men, 1.8 for women). This indicates disparity with a significant predominance of male patients over females as for all shoulder-girdle injuries (p < 0.01). Among children (< 16 years old), the incidence rate showed no significant difference in gender ratio. Conclusion MCIs appear more frequently than estimated so far and are distinguished from other clavicle fractures in that they occur more at higher age and peaking around 50 years. Further work on possible prevention strategies should focus on the most frequently affected groups of men around 20 and 50 years old.

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Section: Discussioncontrasting

confidence: 99%

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

Bakır

Unterkofler

Haralambiev

et al. 2020

Eur J Trauma Emerg Surg

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“…Most of the patients were adolescents who sustained injuries from low-energy trauma. The proportion of those undergoing high-energy trauma, which plays a major role in adults with SCJ injuries, particularly caused by traffic accidents, was low in our patient population [1,19,20]. This finding could be a reason why the proportion of mono-injuries in our patient population was higher than in adults.…”

Section: Plos Onementioning

confidence: 59%

Dislocations of the acromioclavicular and sternoclavicular joint in children and adolescents: A retrospective clinical study and big data analysis of routine data

Kraus

Zwingmann²,

Jablonski

et al. 2020

PLoS ONE

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Background Dislocations of the sternoclavicular joint (anterior/posterior) and acromioclavicular joint (SCJ and ACJ, respectively) are rare injuries in childhood/adolescence, each having its own special characteristics. In posterior SCJ dislocation, the concomitant injuries in the upper mediastinum are most important complication, while in anterior SCJ dislocation there is a risk of permanent or recurrent instability. Methods In a retrospective analysis from seven pediatric trauma centers under the leadership of the Section of Pediatric Traumatology of the German Trauma Society, children (<18 years) were analyzed with focus on age, gender, trauma mechanism, diagnostics, treatment strategy and follow-up results. Additional epidemiological big data analysis from routine data was done. Results In total 24 cases with an average age of 14.4 years (23 boys, 1 girl) could be evaluated (7x ACJ dislocation type ≥ Rockwood III; 17x SCJ dislocation type Allman III, including 12 posterior). All ACJ dislocations were treated surgically. Postoperative immobilization lasted 3–6 weeks, after which a movement limit of 90 degrees was recommended until implant removal. Patients with SCJ dislocation were posterior dislocations in 75%, and 15 of 17 were treated surgically. One patient had a tendency toward sub-dislocation and another had a relapse. Conservatively treated injuries healed without complications. Compared to adults, SCJ injuries were equally rarely found in children (< 1% of clavicle-associated injuries), while pediatric ACJ dislocations were significantly less frequent (p<0.001). Conclusions In cases of SCJ dislocations, our cohort analysis confirmed both the heterogeneous spectrum of the treatment strategies in addition to the problems/complications based on previous literature. The indication for the operative or conservative approach and for the specific method is not standardized. In order to be able to create evidence-based standards, a prospective, multicenter-study with a sufficiently long follow-up time would be necessary due to the rarity of these injuries in children. The rarity was emphasized by our routine data analysis.

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“…Therefore, especially in everyday clinical practice, it is essential to further exclude contra-polar injuries, especially in the case of an injury in the sternoclavicular region but also in the case of any clavicular injury [15,37]. Thus, underdiagnosis or delay can negatively influence the effectiveness of treatment and economy in a negative way [38].…”

Section: Incidence and Subtypes Of Combined Injuriesmentioning

confidence: 99%

“…To avoid these potential consequences, a conceivable alternative would be the recommendation of a CT scan or an MRI in case of a certain grade of trauma mechanism in order to be able to reliably prove or exclude the presence of further injuries in the sense of a CCI. A recommendation in this regard, as recently made for the sternoclavicular region, cannot yet be made and should be analyzed in further studies [38]. The way a CCI influences the outcome compared to mono injuries is not known, and as with determination of the prognoses of the individual CCI types, should be the subject of further investigation [14].…”

Section: Incidence and Subtypes Of Combined Injuriesmentioning

confidence: 99%

Monopolar and Bipolar Combination Injuries of the Clavicle: Retrospective Incidence Analysis and Proposal of a New Classification System

Bakır

Carbon

Schulz-Drost

2021

JCM

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Clavicle injuries are common, but only few case reports describe combined clavicular injuries (CCI). CCI include combinations between clavicular fractures and acromioclavicular/sternoclavicular joint dislocations (SCJD). We present the first general therapeutic recommendations for CCI based on a new classification and their distribution. A retrospective, epidemiological, big data analysis was based on ICD-10 diagnoses from 2012 to 2014 provided by the German Federal Statistical Office. CCI represent 0.7% of all clavicle-related injuries (n = 814 out of 114,003). SCJD show by far the highest proportion of combination injuries (13.2% of all SCJD were part of CCI) while the proportion of CCI in relation to the other injury entities was significantly less (p < 0.023). CCIs were classified depending on (1) the polarity (monopolar type I, 92.2% versus bipolar type II, 7.8%). Monopolar type I was further differentiated depending on (2) the positional relationship between the combined injuries: Ia two injuries directly at the respective pole versus Ib with an injury at one end plus an additional midshaft clavicle fracture. Type II was further differentiated depending on (3) the injured structures: IIa ligamento-osseous, type IIb purely ligamentous (rarest with 0.6%). According to our classification, the CCI severity increases from type Ia to IIb. CCI are more important than previously believed and seen as an indication for surgery. The exclusion of further, contra-polar injuries in the event of a clavicle injury is clinically relevant and should be focused.

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Injuries of the sternoclavicular region indicate concomitant lesions and need distinguished imaging

Cited by 6 publications

References 14 publications

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

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

Dislocations of the acromioclavicular and sternoclavicular joint in children and adolescents: A retrospective clinical study and big data analysis of routine data

Monopolar and Bipolar Combination Injuries of the Clavicle: Retrospective Incidence Analysis and Proposal of a New Classification System

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