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European Journal of Trauma and Emergency Surgery

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Open Access 05-11-2021 | Thoracic Trauma | Original Article

The significance of a concomitant clavicle fracture in flail chest patients: incidence, concomitant injuries, and outcome of 12,348 polytraumata from the TraumaRegister DGU^®

Authors: Mustafa Sinan Bakir, Andreas Langenbach, Melina Pinther, Rolf Lefering, Sebastian Krinner, Marco Grosso, Axel Ekkernkamp, Stefan Schulz-Drost, the TraumaRegister DGU

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2022

Abstract

Purpose

Isolated clavicle fractures (CF) rarely show complications, but their influence in the thorax trauma of the seriously injured still remains unclear. Some authors associate CF with a higher degree of chest injuries; therefore, the clavicle is meant to be a gatekeeper of the thorax.

Methods

A retrospective analysis of the TraumaRegister DGU^® (project 2017-10) was carried out involving the years 2009–2016 (ISS ≥ 16, primary admission to a trauma center). Cohort formation: unilateral and bilateral flail chest injuries (FC), respectively, with and without a concomitant CF.

Results

73,141 patients (26.5% female) met the inclusion criteria and 12,348 had flail chest injuries (FC; 20.0% CF; 67.7% monolateral FC), 25,425 other rib fractures (17.7% CF), and 35,368 had no rib fractures (6.5% CF). On average, monolateral FC patients were 56.0 ± 17.9 years old and bilateral FC patients were 57.7 ± 19 years old. The ISS in unilateral and bilateral FC were 29.1 ± 11.7 and 42.2 ± 12.9 points, respectively. FC with a CF occurred more frequently with bicycle and motorbike injuries in monolateral FC and pedestrians in bilateral FC injuries and less frequently due to falls. Patients with a CF in addition to a FC had longer hospital and ICU stays, underwent artificially respiration for longer periods, and died less often than patients without a CF. The effects were highly significant in bilateral FC. CF indicates more relevant concomitant injuries of the lung, scapula, and spinal column. Moreover, CF was associated with more injuries of the extremities in monolateral CF.

Conclusion

Due to the relevance of a concomitant CF fracture in FC, diagnostics should focus on finding CFs or rule them out. Combined costoclavicular injuries are associated with a significantly higher degree of thoracic injuries and longer hospital stays.

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Title: The significance of a concomitant clavicle fracture in flail chest patients: incidence, concomitant injuries, and outcome of 12,348 polytraumata from the TraumaRegister DGU®
Authors: Mustafa Sinan Bakir
Andreas Langenbach
Melina Pinther
Rolf Lefering
Sebastian Krinner
Marco Grosso
Axel Ekkernkamp
Stefan Schulz-Drost
the TraumaRegister DGU
Publication date: 05-11-2021
Publisher: Springer Berlin Heidelberg
Keywords: Thoracic Trauma
Clavicle Fracture
Rib Fracture
Thoracic Trauma
Published in: European Journal of Trauma and Emergency Surgery / Issue 5/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-021-01819-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The significance of a concomitant clavicle fracture in flail chest patients: incidence, concomitant injuries, and outcome of 12,348 polytraumata from the TraumaRegister DGU^®

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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