Shoulder injuries in polytraumatized patients: an analysis of the TraumaRegister DGU®

Briese, Thorben; Theisen, Christina; Schliemann, Benedikt; Raschke, Michael J.; Lefering, Rolf; Weimann, André

doi:10.1007/s00068-020-01340-1

Cited by 8 publications

(7 citation statements)

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“…3 Patients with polytrauma have a high prevalence of shoulder injuries of up to 28%, with 3% consisting of ACJ injuries, that are associated with severe thoracic injuries. 1,2 Data are reported as mean ± SD unless otherwise indicated. Boldface P values indicate a statistically significant difference between groups (P < .05).…”

Section: Discussionmentioning

confidence: 99%

“…6,18 An ACJ injury can be a concomitant or associated injury in patients with polytrauma or thoracoabdominal injuries. 1,2 Supine or upright chest radiography is the standard investigation tool that is used as an adjunct in the primary survey of patients with polytrauma. Chest radiography can detect bony injuries such as in the scapula, clavicle, and ribs or evaluate cardiopulmonary abnormalities.…”

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confidence: 99%

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Reliability of Upright Chest Radiography as a Diagnostic Screening Tool for Acromioclavicular Joint Dislocations

Chaichana

Apivatgaroon

Rujiraphum

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: The standard radiographic view for diagnosing acromioclavicular joint (ACJ) dislocations is the Zanca view of both shoulders to assess superior displacement of the distal clavicle by measuring the coracoclavicular distance (CCD) and comparing it with the uninjured shoulder; however, there is no consensus on a gold standard for diagnostic measures to classify acute ACJ injuries. Purpose: To compare the CCD from an upright chest radiograph with a standard Zanca view of both shoulders in patients with an ACJ dislocation. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: We reviewed the records of 70 patients with an ACJ dislocation between 2010 and 2021 who had both an upright chest radiograph and a Zanca view. An ACJ dislocation was classified as low grade (Rockwood types 1-3) or high grade (Rockwood type 5). The CCD was measured on the upright chest radiograph and the Zanca view by 2 independent reviewers, and the percentage of the CCD difference compared with the unaffected side (ΔCCD) was calculated and compared between the upright chest radiograph and the Zanca view. Interrater and intrarater reliability were determined using the intraclass correlation coefficient. Results: Included were 70 patients (55 male and 15 female; mean age, 46 years). There were 29 patients (41.43%) with a low-grade injury and 41 patients (58.57%) with a high-grade injury. In the overall analysis, the ΔCCD on the upright chest radiograph and Zanca view was significantly different (130.25% ± 88.42% vs 152.69% ± 106.56%, respectively; mean difference, 22.44% [95% CI, 2.40% to 42.48%]; P = .029). The subgroup analysis revealed that the ΔCCD on the upright chest radiograph and Zanca view was significantly different for patients with a low-grade injury (60.71% ± 25.79% vs 91.46% ± 68.54%, respectively; mean difference, 30.76% [95% CI, 7.18% to 54.33%]; P = .012) but not different for patients with a high-grade injury (179.45% ± 83.87% vs 196.00% ± 107.97%, respectively; mean difference, 16.56% [95% CI, –14.06% to 47.18%]; P = .281). The intraclass correlation coefficients for the ΔCCD measurements indicated good to excellent interrater and intrarater reliability. Conclusion: The study findings indicated that upright chest radiography can be used as a diagnostic screening tool for high-grade ACJ dislocations, but not for low-grade ACJ injuries, compared with the Zanca view.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Reliability of Upright Chest Radiography as a Diagnostic Screening Tool for Acromioclavicular Joint Dislocations

Chaichana

Apivatgaroon

Rujiraphum

et al. 2023

Orthopaedic Journal of Sports Medicine

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“…In 42.0% of cases the clavicular fracture was treated operatively. A study with older data reviewing the years 2002-2013 in the TraumaRegister DGU® described an even higher rate of 52.4% operative treatments [33], which might be due to more generous inclusion criteria, as all patients with an ISS ≥ 16 were included.…”

Section: Discussionmentioning

confidence: 99%

Surgical Stabilization of Clavicle Fractures Reduces Organ Failure Rates in Multiply-injured Patients with Thoracic Trauma: An Analysis Based on the TraumaRegister DGU®.

Eberbach

Lefering

Hager³

et al. 2020

Preprint

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Introduction: Thoracic trauma has decisive influence on the outcome of multiply-injured patients and is often associated with clavicle fractures. The affected patients are prone to lung dysfunction and multiple organ failure. The aim of this study is to investigate the influence of surgical stabilization of clavicle fractures in patients with thoracic trauma on specific outcome parameters.Methods: A multi-center, retrospective analysis of patient records documented in the TraumaRegister DGU® between 2009 and 2015 was performed. The inclusion criteria were multiply-injured patients with thoracic trauma and associated clavicle fracture, maximum AIS severity ≥ 3 and admission to the intensive care unit. The influence of operative vs. non-operative clavicular fracture treatment and timing of surgery on lung failure, multiple organ failure, sepsis, length of ICU stay, intubation time and length of hospital stay was assessed by regression analysis.Results: A total of 3,209 patients were included in the analysis. In 1,362 patients (42%) the clavicle fracture was treated operatively after 7.1 ± 5.3 days. Surgically treated patients had a significant reduction in lung failure (p = 0.013, OR = 0.74), multiple organ failure (p = 0.001, OR = 0.64), intubation time (p = 0.004; -1.81 days) and length of hospital stay (p = 0.014; -1.51 days) compared to non-operative treatment. Moreover, surgical fixation of the clavicle within five days following hospital admission significantly reduced the rates of lung failure (p = 0.01, OR = 0.62), multiple organ failure (p = 0.01, OR = 0.59) and length of hospital stay (p = 0.01; -2.1 days).Conclusions: Based on our results, multiply-injured patients with thoracic trauma and concomitant clavicle fracture seem to benefit significantly from surgical stabilization of a clavicle fracture, especially when surgery is performed within the first five days after hospital admission.

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“…PHFs are the second most common fractures of the upper extremities for the elderly, with constant increase in the number of patients suffering from PHFs [ 1 , 2 ] and account for 5–6% of all fractures in the emergency department (incidence of 82 per 100,000 patients) [ 3 , 4 ]. In severely injured patients (ISS ≥ 16), upper extremity fractures occurred in 21%, (9–23%) of cases [ 5 , 6 ]. A fractured humerus required surgical treatment in 68.6% cases [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…In severely injured patients (ISS ≥ 16), upper extremity fractures occurred in 21%, (9–23%) of cases [ 5 , 6 ]. A fractured humerus required surgical treatment in 68.6% cases [ 5 , 6 ]. PHILOS is the one of the favored bone-preserving surgical treatment for PHF [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Does the magnitude of injuries affect the outcome of proximal humerus fractures treated by locked plating (PHILOS)?

Berk

Halvachizadeh

Bellmann

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Health-related quality of life (HRQoL) becomes increasingly relevant in an aging society. Functional outcome (FO) and the patient-reported outcome (PRO) after surgical treatment of proximal humerus fractures (PHF) depends on numerous factors, including patient-and injury-specific factors. There is little evidence on how the FO and the PRO vary in different settings such as monotrauma or multiple injuries, even though the PHF is one of the more frequent fractures. In addition, to a previous study, on multiple injured patients and upper extremity injuries, the aim of the current study was to investigate the impact of multiple injuries, quantified by the ISS, on the FO and PRO after surgically treated PHF by PHILOS. Methods A retrospective cohort-study was conducted with an additional follow-up by a questionnaire. HRQoL tools such as range of motion (ROM), the Quick-Disability of Arm Shoulder and Hand score (DASH), EuroQol Five Dimension Three Levels (EQ-5D-3L), and EuroQol VAS (EQ-VAS) were used. The study-population was stratified according to ISS obtained based on information at discharge into Group I/M-H (ISS < 16 points) and Group PT-H (ISS ≥ 16). Median outcome scores were calculated and presented. Inclusion criteria: adult patients (> 18 years) with PHF treated at one academic Level 1 trauma center between 2007 and 2017 with Proximal Humeral Inter-Locking System (PHILOS) and preoperative CT-scan. Group stratification according Injury Severity Score (ISS): Group PT-H (ISS ≥ 16 points) and Group I/M-H (ISS < 16 points). Exclusion criteria: oncology patients, genetic disorders affecting the musculoskeletal system, paralysis or inability to move upper extremity prior or after injury, additional ipsilateral upper limb fractures, open injuries, associated vascular injuries as well brachial plexus injuries and nerve damages. Follow-up 5-10 years including PRO: EQ-5D-3L and EQ-VAS. FO, including DASH and ROM. The ROM was measured 1 year after PHILOS. Results Inclusion of 75 patients, mean age at injury was 49.9 (± 17.6) years. The average follow-up period in Group I/M-H was 6.18 years (± 3.5), and in Group PT-H 5.58 years (± 3.1). The ISS in the Group I/M-H was 6.89 (± 2.5) points, compared to 21.7 (± 5.3) points in Group PT-H (p ≤ 0.001). The DASH-score in Group I/M-H was 9.86 n.s.). The EQ-VAS in Group I/M-H was 78.13 (± 19.77) points compared with 74.13 (± 19.43, n.s.) in Group PT-H. DASH, EQ-VAS as well as ROM were comparable in Groups I/M-H and PT-H (9.9 ± 13.1 versus 12.4 ± 15.5, n.s.). The EQ-5D-3L in Group I/M-H was 0.86 (± 0.23) points compared to Group PT-H 0.72 (± 0.26, p ≤ 0.017). No significant differences could be found in Group I/M-H and PT-H in the severity of traumatic brain injury (TBI). A multivariable regression analyses was performed for DASH, EQ-5D-3L and EQ-VAS. All three outcome metrics were correlated. There was a significant difference between the EQ-5D-3L and the ISS (Beta-Coefficient was 0.86, 95% low was 0.75, 95% high was 0.99, p ≤ 0.041). No significant correlation could be ...

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Shoulder injuries in polytraumatized patients: an analysis of the TraumaRegister DGU®

Cited by 8 publications

References 50 publications

Reliability of Upright Chest Radiography as a Diagnostic Screening Tool for Acromioclavicular Joint Dislocations

Reliability of Upright Chest Radiography as a Diagnostic Screening Tool for Acromioclavicular Joint Dislocations

Surgical Stabilization of Clavicle Fractures Reduces Organ Failure Rates in Multiply-injured Patients with Thoracic Trauma: An Analysis Based on the TraumaRegister DGU®.

Does the magnitude of injuries affect the outcome of proximal humerus fractures treated by locked plating (PHILOS)?

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