Influence of surgical stabilization of clavicle fractures in multiply-injured patients with thoracic trauma

Helge Eberbach,Sven Hager,Thorsten Hammer,Lisa Bode,Jörg Bayer,Dirk Maier,Martin Jaeger,Hagen Schmal,Klaus Schumm,Rolf Lefering,Johannes Kalbhenn

doi:10.1038/s41598-021-02771-5

Abstract

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. A multi-center, retrospective analysis of patient records documented in the TraumaRegister DGU was performed to assess the influence of surgical stabilization of clavicle fractures in patients with thoracic trauma. A total of 3,209 patients were included in the analysis. In 1362 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). Based on our results, multiply-injured patients with thoracic trauma and concomitant clavicle fracture may benefit significantly from surgical stabilization of a clavicle fracture, especially when surgery is performed within the first five days after hospital admission.

Highlights

Thoracic trauma has decisive influence on the outcome of multiply-injured patients and is often associated with clavicle fractures
After applying inclusion and exclusion criteria a total of 3,209 multiply-injured patients with thoracic trauma and concomitant clavicle fracture remained for analysis (Fig. 1)
The most important finding of our present retrospective study evaluating 3209 multiply-injured patients is that operative stabilization of concomitant clavicle fractures in patients with thoracic trauma has decisive positive effects on clinically relevant outcome parameters

Summary

Introduction

Thoracic trauma has decisive influence on the outcome of multiply-injured patients and is often associated with clavicle fractures. 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. Multiply-injured patients with thoracic trauma and concomitant clavicle fracture may benefit significantly from surgical stabilization of a clavicle fracture, especially when surgery is performed within the first five days after hospital admission. In multiply-injured patients sustaining a clavicle fracture concomitant thoracic injuries occur in 77%9. An intact and stable clavicle, as the origin of the accessory inspiratory muscles, is a crucial prerequisite for effective respiration and o xygenation[16,17]

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