Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 1/2019

01-02-2019 | Original Article

Associated thoracic injury in patients with a clavicle fracture: a retrospective analysis of 1461 polytrauma patients

Authors: J. J. E. M. van Laarhoven, F. Hietbrink, S. Ferree, A. C. Gunning, R. M. Houwert, E. M. M. Verleisdonk, L. P. H. Leenen

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2019

Login to get access

Abstract

Purpose

During primary survey the main goal is to ascertain life-threatening injuries. A chest X-ray is recommended in all polytrauma patients as thoracic injury plays an important role in mortality. However, treatment-dictating injuries are often missed on the chest X-ray. In contrast, clavicle fractures should be relatively easy to diagnose on a chest X-ray. We previously showed that clavicle fractures occur in approximately 10 % of all polytrauma patients in our population. The aim was to compare polytrauma patients, with and without a clavicle fracture, to investigate if a clavicle fracture is associated with concomitant thoracic injury.

Methods

A retrospective cohort study of polytrauma patients (ISS ≥ 16) from 2007 until 2011. Thoracic injuries were defined as: ribfracture, pneumothorax, lung contusion, sternum fracture, hemothorax, myocardial contusion, thoracic aorta injury and thoracic spine injury.

Results

Of 1461 polytrauma patients in 160 patients a clavicle fracture was diagnosed, and 95 % was diagnosed on chest X-ray. Patients with a clavicle fracture had a higher mean Injury Severity Score (ISS) (29.2 ± 10.1 vs. 24.9 ± 9.1; P < 0.001). Additional thoracic injuries were more prevalent in patients with a clavicle fracture (76 vs. 47 %; OR 3.6; 95 % CI 2.45–5.24) and they had a higher rate of thoracic injury with an AIS ≥ 3 (66 vs. 41 %; OR 2.8; 95 % CI 1.97–3.93).

Conclusions

The clavicle can be seen as the gatekeeper of the thorax. In polytrauma patients, a clavicle fracture is easily diagnosed during primary survey and may indicate underlying thoracic injury, as the rate and extent of concomitant thoracic injury are high.
Literature
1.
American College of Surgeons. Advanced trauma life support for doctors. Student course manual 7th edn.2004 Chicago, IL: American College of Surgeons.
2.
3.
Stellin G. Survival in trauma victims with pulmonary contusion. Am Surg. 1991;57:780–4.PubMed
4.
Pape HC, Auf’m’Kolk M, Paffrath T, Regel G, Sturm JA, Tscherne H. Primary intramedullary femur fixation in multiple trauma patients with associated lung contusion—a cause of posttraumatic ARDS? J Trauma. 1993;34(4):540–7.CrossRefPubMed
5.
Hietbrink F, Koenderman L, Leenen LP. Intramedullary nailing of the femur and the.systemic activation of monocytes and neutrophils. World J Emerg Surg. 2011;6:34.CrossRefPubMedPubMedCentral
6.
Pape HC, Remmers D, Rice J, Ebisch M, Krettek C, Tscherne H. Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. J Trauma. 2000;49(3):496–504.CrossRefPubMed
7.
Rk Lee, Graham CA, Yeung JH, Ahuja AT, Rainer TH. Occult pneumothoraces in.12.Chinese patients with significant blunt chest trauma: radiological classification and proposed.13.clinical significance. Injury. 2012;43(12):2105–8.CrossRef
8.
Exadaktylos AK, Sclabas G, Schmid SW, Schaller B, Zimmermann H. Do we really need routine computed tomographic scanning in the primary evaluation of blunt chest trauma in patients with “normal” chest radiograph? J Trauma. 2001;51(6):117306.
9.
Aukema TS, Beenen LF, Hietbrink F, Leenen LP. Initial assessment of chest X-ray in thoracic trauma patients: awareness of specific injuries. World J Radiol. 2012;4(2):48–52.CrossRefPubMedPubMedCentral
10.
van Laarhoven JJ, Ferree S, Houwert RM, Hietbrink F, Verleisdonk EM, Leenen LP. Demographics of the injury pattern in severely injured patients with an associated clavicle fracture: a retrospective observational cohort study. World J Emerg Surg. 2013;8:36.CrossRefPubMedPubMedCentral
11.
Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.CrossRefPubMed
12.
Committee on Injury Scaling. The abbreviated Injury Scale. revision (AIS-98) 1998. Des Plaines (IL): Association for the Advancement of Automotive Medicine; 1998.
13.
Ciesla DJ, Moore EE, Jonson JL, Cothren CC, Banerjee A, Burch JM, Sauaia A. Decreased progression of post injury lung dysfunction to the acute respiratory distress syndrome and multiple organ failure. Surgery. 2006;140(4):640–7.CrossRefPubMed
14.
Vécsei V, Arbes S, Aldrian S, Nau T. Chest injuries in polytrauma. Eur J Trauma. 2005;31:239–43.CrossRef
15.
16.
Hp Gottschalk, Browne RH, Starr AJ. Shoulder girdle: patterns of trauma and associated injuries. J Orthop Trauma. 2011;25(5):266–71.CrossRef
17.
Brenner DJ, Hall EJ, Phil D. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–84.CrossRefPubMed
18.
Trupka A, Waydhas C, Hallfeldt KK, Nast-Kolb D, Pfeifer KJ, Schweiberer L. Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study. J Trauma. 1997;43(3):405–11.CrossRefPubMed
19.
McGonigal MD, Schwab CW, Kauder DR, Miller WT, Grumbach K. Supplemental emergent chest computed tomography in the management of blunt torso trauma. J Trauma. 1990;30(12):1431–4.CrossRefPubMed
20.
Rodriguez RM, Anglin D, Langdorf MI, Baumann BM, Hendey GW, Bradley RN, et al. Nexus chest. validation of a decision instrument for selective chest imaging in blunt trauma. JAMA Surg. 2013;148(10):940–6.CrossRefPubMed
Metadata
Title
Associated thoracic injury in patients with a clavicle fracture: a retrospective analysis of 1461 polytrauma patients
Authors
J. J. E. M. van Laarhoven
F. Hietbrink
S. Ferree
A. C. Gunning
R. M. Houwert
E. M. M. Verleisdonk
L. P. H. Leenen
Publication date
01-02-2019
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 1/2019
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-016-0673-6

Other articles of this Issue 1/2019

European Journal of Trauma and Emergency Surgery 1/2019 Go to the issue

Original Article

Civilian cerebral gunshot wounds in rural South African patients are associated with significantly higher mortality rates than in urban patients

Original Article

Preparing Japanese surgeons for potential mass casualty situations will require innovative and systematic programs

Original Article

Trauma-induced coagulopathy upon emergency room arrival: still a significant problem despite increased awareness and management?

Original Article

Prognostic potential of markers of bone turnover in delayed-healing tibial diaphyseal fractures

Original Article

Which pre-hospital triage parameters indicate a need for immediate evaluation and treatment of severely injured patients in the resuscitation area?

Original Article

Injury severity in polytrauma patients is underestimated using the injury severity score: a single-center correlation study in air rescue