What are the predictors of scapula fractures in high-impact blunt trauma patients and why do we miss them in the emergency department?

Uzkeser, Mustafa; Emet, Mücahit; Kılıç, Mesut; Işık, Memet

doi:10.1007/s00068-011-0139-9

Cited by 6 publications

(6 citation statements)

References 16 publications

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“…In severely injured patients, severe thoracic trauma increases the morbidity and mortality especially due to the increased risk of developing an acute respiratory distress syndrome (ARDS) [ 3 , 37 , 38 ]. Previous studies showed that up to 23.5% of thoracic injuries and 35.7% of scapula fractures are initially overlooked [ 4 , 15 ]. Therefore, thoracic injuries should always be considered in the occurrence of shoulder injuries.…”

Section: Discussionmentioning

confidence: 99%

“…In the present literature, several studies highlight the relevance of scapular fractures in a severe trauma or shoulder injuries in general [11][12][13][14][15]. Nevertheless, there are no studies of the TraumaRegister DGU® or similar international databases available that provide a complete overview of injuries of the shoulder in severe multiple trauma and their association with outcome, trauma mechanisms, or concomitant injuries.…”

Section: Introductionmentioning

confidence: 99%

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

Briese

Theisen

Schliemann

et al. 2020

Eur J Trauma Emerg Surg

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Background The aim of the present study was to analyze the prevalence, epidemiology and relevance of shoulder injuries in polytraumatized patients in a large national trauma database. We hypothesize a high prevalence of shoulder injuries in traffic accidents and a high prevalence of concomitant injuries of the thorax leading to an aggravated clinical course and higher Injury Severity Score (ISS). Furthermore, we hypothesize an increased rate of surgical treatment with the severity of the injury. Materials and methods The retrospective analysis is based on the database (2002-2013) of the TraumaRegister DGU® and includes statistical data from 608 hospitals. The severity of injuries and trauma were scaled using the Abbreviated Injury Scale (AIS), and the Injury Severity Score (ISS), respectively. Patients with an ISS ≥ 16 were included in the study, and injuries were subdivided according to their anatomical involvement and analyzed with respect to the trauma mechanism and the resulting injuries. Results In this study, 54,076 cases of patients with an ISS ≥ 16 were analyzed. Shoulder injuries occurred in 15,115 patients (27.9%). Of these, 68.5% were caused by traffic accidents, especially in motorbike, bicycle, and pedestrian accidents. We found more shoulder injuries in blunt trauma mechanisms. Moreover, patients with shoulder injuries spent on average 1.7 more days on the intensive care unit (ICU), or intermediate care unit (IMCU), according to the severity of the injury, and had longer overall hospital stays (26.2 vs. 24.1 days) than patients without shoulder injuries. The overall ISS was increased in patients with shoulder injuries, whereas an increase of mortality could not be identified. Concomitant thoracic injuries occurred significantly more often in patients with shoulder injuries (82.9% vs. 69.6%). Injuries of the abdomen, pelvis, and lower extremity showed no correlation with shoulder injuries, whereas head and spine injuries showed a significant correlation. Conclusion Shoulder injuries are very common in polytraumatized patients. Together with their distinctive concomitant injuries, they have an aggravating impact on the clinical progress. Our data confirm the correlation with thoracic injuries. Furthermore, we identified an increased risk of shoulder injuries in motorbike, bicycle, and pedestrian accidents. An increase in mortality could not be identified.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Briese

Theisen

Schliemann

et al. 2020

Eur J Trauma Emerg Surg

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“…Scapular fractures in adults are usually the result of a direct blow and are often associated with clavicular or rib fractures [113]. Nowadays, scapular fractures mostly occur in motor vehicle accidents, falls from a height and assaults [119]. Bilateral fractures of the body have also been reported in epileptic seizures and electrocution [120].…”

Section: Discussionmentioning

confidence: 99%

Evidence of infectious disease, trauma, disability and deficiency in skeletons from the 19th/20th century correctional facility and asylum «Realta» in Cazis, Switzerland

2019

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As a reaction to widespread poverty, a system of coercive welfare developed in Switzerland during the 19 th century. Poverty was often thought to result from an individual’s misconduct rather than from structural, economic or political circumstances. People whose lifestyle deviated from the desired norm or who were unable to make a living for themselves were subjected to so-called administrative detention at institutions such as workhouses and poorhouses. The excavation of the cemetery of the correctional facility/workhouse and asylum «Realta» in Cazis offered the opportunity to gain insight into the living conditions of a marginalized group of people and to shed light on aspects of coercive welfare that have hardly been addressed in historical studies. A comprehensive study of pathological alterations was used to assess possible physical causes and effects of administrative detention. Skeletal samples from regular contemporaneous cemeteries provided data for the general population and thus allowed us to detect peculiarities in the «Realta» assemblage. Possible cases of Stickler Syndrome, microcephaly, congenital syphilis, endemic hypothyroidism and disabilities secondary to trauma may have been the reason for the affected individuals’ institutionalisation. The high prevalence of tuberculosis was linked to the socioeconomic status and the living conditions at the facility. Several cases of scurvy and osteomalacia may have resulted from various risk factors such as poverty, alcoholism, mental illness or institutionalisation. The fracture rates, especially of ribs, were extremely high. A large proportion of the fractures were incompletely healed and most likely occurred during detention due to interpersonal violence. Underlying diseases further contributed to the high fracture rates. This first study on skeletons from an institution of administrative detention in Switzerland demonstrated how pre-existing health conditions and the socioeconomic background contributed to the chance of being detained, and how detention led to further deterioration of health.

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“…However, he did not mention bilateral fractures. Outstanding in this respect is the study by Uzkeser et al [24]. In a group of 1,039 patients with high-impact blunt trauma, these authors recorded a scapular fracture in 42 cases (4 %), of which 25 % were overlooked on CT scans.…”

Section: Discussion and Literature Overviewmentioning

confidence: 99%

“…The prognostic relevance of scapular fractures in polytraumatised patients is the subject of widespread debate [23,24,27]. Some authors state that polytraumatised patients with a scapular fracture have more severe injuries and higher mortality rates, whereas other authors claim that such patients have more severe injuries to the chest but a lower mortality rate.…”

Section: Discussion and Literature Overviewmentioning

confidence: 99%

Bilateral scapular fractures in adults

Tuček¹,

Bartoníček²,

Novotny³

et al. 2013

International Orthopaedics (SICOT)

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Purpose Bilateral scapular fracture is a very rare injury. Most of these fractures result from electrical shock or epileptic seizure. We treated six patients with such injuries, all of them caused by direct violence. The aim of this study was to report on the patients and to present an overview of the cases published so far. Methods Between January 2011 and August 2012, we treated six patients with bilateral scapular fractures (four men and two women, age range 20-78 years). Another 11 cases were found in the literature. All cases were analysed in terms of injury mechanism, fracture pattern and the manner of diagnosis. Results Our six patients increased the total number of recorded cases to 17 and the number of patients with traumatic bilateral scapular fractures from four to ten. In five of our cases, the injuries were classified as being the result of high-energy trauma. Computed tomography (CT) examination of the affected scapulae was performed in all six cases, in five in combination with 3D CT reconstruction; in one polytraumatised female patient, only axial CT scans were obtained. In all five high-energy trauma cases, bilateral fracture of the scapular body was recorded, of which one was classified as open. Four of the 11 cases found in the literature were caused by direct violence: in six patients, the fractures resulted from muscle spasms associated with epileptiform seizure or electrical shock, and one patient suffered a pathological fracture associated with amyloidosis. The most frequently recorded fracture in all 17 patients (34 fractures) was of the scapular body, i.e. 24 fractures, followed by 12 fractures of the glenoid fossa. Conclusion According to data in the literature, bilateral scapular fracture is a rare injury. One reason may be that the potential incidence is often neglected. With the increasing number of patients with polytrauma, the potential for scapular fracture should always be taken into account, together with the fact that this injury may be bilateral. Of vital importance in diagnosing these injuries is CT scanning, including 3D CT reconstructions.

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What are the predictors of scapula fractures in high-impact blunt trauma patients and why do we miss them in the emergency department?

Cited by 6 publications

References 16 publications

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

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

Evidence of infectious disease, trauma, disability and deficiency in skeletons from the 19th/20th century correctional facility and asylum «Realta» in Cazis, Switzerland

Bilateral scapular fractures in adults

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