Injuries of the posterior and lateral chest wall-importance of an additional clavicular fracture

Abstract

Flail chest wall injuries (FCI) are common in younger patients due to high-speed trauma and in older patients due to low-energy trauma or falls from a low height. They show ahigh incidence of concomitant injuries and are therefore associated with high morbidity and mortality. If there is also an ipsilateral clavicular fracture (CF), the outcome is significantly poorer. The skeleton of the shoulder and chest loses stability and can lead to aloss of function of the shoulder and apronounced deformation of the chest wall. This article shows the origin and clinical importance of FCI. What importance does aconcomitant ipsilateral CF have and how can these costoclavicular injuries (CCI) be managed conservatively and operatively? After primary emergency care of the patients with appropriate diagnostics, in the presence of CCI operative stabilization was carried out by means of locked plate osteosynthesis of the clavicle and the affected ribs via minimally invasive approaches with the patient under general anesthesia. Patients were followed up postoperatively. Various minimally invasive posterolateral approaches to the chest wall were previously performed in acorpse study and then put into practice. This study presents therapeutic options for the reconstruction of the chest wall based on the established literature and clinical examples. An ipsilateral CF combined with fractures of the2nd-4th ribs can be treated through an innovative clavipectoral approach. For the other fractures, standard approaches to the anterolateral and posterolateral chest wall are performed, which are associated with a good outcome in clinical practice. An operative stabilization should be performed at the latest when FCI or CCI together with a dislocating fracture and amarked deformation of the thoracic wall are present. Remaining misalignments are associated with asimultaneous loss of function of the chest wall and shoulder.