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

Abstract

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.

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

“…Among those affected, the age pattern showed its peak around the age of 50 years. This confirms previous studies in patients with shoulder-girdle injuries 9 , 23 . Since there is generally a similar age distribution for the severely injured, this does not differ from one another 24 .…”

“…Due to the anatomic proximity, rib fractures are more likely to result from SCJ rather than from ACJ injuries 2 . However, since the incidence of ACJ injuries is also many times higher than that of SCJ injuries, this ratio in favor of ACJ injuries would lower the average probability of rib fractures in the CJI group 9 .This ratio would also explain the more common rib fracture as a concomitant injury in CF although hypothetically this should be more common in SCJ injuries than in CF.…”

“…Since there is generally a similar age distribution for the severely injured, this does not differ from one another 24 . A second, lower peak describes the group of patients from 20 to 25 years, who is often associated with increased risk behavior and is considered to be particularly at risk for severe injuries, also in the area of the clavicle 9 , 24 – 26 .…”

“…Clavicular combination injuries of CJI, including a coincident CF, could be viewed as the most complex entity of CJI with CJI being more frequently associated with CF than in every 10 th case. These combination injuries are rare but have hardly been investigated and should be investigated further because of the difficulty in diagnoses 2 , 3 , 9 , 12 , 30 – 32 .…”

“…The clavicle has a particular importance due to its function as a connection from the upper extremity to the trunk 1 . 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 .…”