Abstract
BackgroundThoracic and extremity injuries are common in polytraumatized patients. The clavicle limits the upper thoracic cage and connects the body and upper extremities. It is easy to examine and is visible on standard emergency room radiographs. We hypothesize that clavicular fracture in polytrauma patients indicates the presence of further injuries of the upper extremities, head, neck and thorax.Material and methodsRetrospective study including patients admitted between 2008 and 2012 to a level-I trauma center. Inclusion criteria: ISS > 16, two or more injured body regions, clavicular fracture. Control group: patients admitted in 2011, ISS > 16, two or more injured body regions, no clavicular fracture. Patient information was obtained from the patients’ charts; evaluation of radiographic findings was performed; scoring was based on the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) AIS/ISS; data were analyzed using Pearson’s correlation and the Mann–Whitney U-test in SPSS (version 11.5.1); graphs were drawn using EXCEL®.ResultsThirty-four patients with clavicular fracture (C+) and 40 without (C-) were included; the mean ISS was 25 (range 16–57), m = 70%, f = 30%; age 43.3 years (range 9–88); clavicular fractures were positively correlated with severe thoracic (p = 0.011, OR 4.5: KI 1.3–15.3), external (p < 0.001, OR 9.2: KI 2.7–30.9) and upper extremity injuries (p < 0.001, OR 33.2: KI 6.9–16.04 resp. p = 0.004, OR 12.5: KI 1.5–102.9). C + showed a lower head/neck AIS (p = 0.033), higher thorax AIS (p = 0.04), arm/shoulder AIS (p = 0.001) and external AIS (0.003) than C-. Mean hospital stay and ICU treatment time were longer in the C + group (p = 0.001 and p = 0.025 respectively).ConclusionA clavicular fracture can be diagnosed easily and may be used as a pointer for further thoracic and upper extremity injuries in polytrauma patients that might have been otherwise missed. Special attention should be paid on second and tertiary survey.
Highlights
Accidents are the leading cause of death in children and young adults
Thirty-four patients with clavicular fracture (C+) and 40 without (C-) were included; the mean Injury Severity Score (ISS) was 25, m = 70%, f = 30%; age 43.3 years; clavicular fractures were positively correlated with severe thoracic (p = 0.011, OR 4.5: KI 1.3–15.3), external (p < 0.001, OR 9.2: KI 2.7–30.9) and upper extremity injuries (p < 0.001, OR 33.2: KI 6.9–16.04 resp. p = 0.004, OR 12.5: KI 1.5–102.9)
Plain radiographs were evaluated by independent investigators and trauma severity was scored using the Abbreviated Injury Scale (AIS-90) and the Injury Severity Score
Summary
Accidents are the leading cause of death in children and young adults. In 2010 20,242 people died in Germany following a severe accident [1]. The most severe injuries are found in the thoracic and abdominal area and in the long bones. Once the emergency procedure is widely accepted. Beside typical thoracic injuries such as rip series fracture, hemopneumothorax or suspicious mediastinal signs, additional information such as the presence of clavicular fractures can be obtained from the x-ray. We hypothesize that a clavicular fracture in polytraumatized patients is suggestive of additional upper extremity injuries. We evaluate the circumstances that are responsible for the diagnosis of missed injuries in the upper extremity area and describe strategies to limit these pitfalls. Thoracic and extremity injuries are common in polytraumatized patients. It is easy to examine and is visible on standard emergency room radiographs. We hypothesize that clavicular fracture in polytrauma patients indicates the presence of further injuries of the upper extremities, head, neck and thorax
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