Widening of sternoclavicular joint distances in blunt chest trauma

Abstract

Purpose: Blunt chest trauma has high mortality and morbidity rates. The aim of this study was to evaluate the relationship between trauma findings and sternoclavicular joint (SCJ) distances in patients with blunt chest trauma. 
 Materials and Methods: Between May 2019- September 2019, Thorax Computed Tomography (CT) images of 102 patients (78 males, 24 females, aged 19-88 years) with blunt chest trauma were evaluated retrospectively. Rib fractures, costal cartilage fractures and other signs of trauma were evaluated. SCJ distances were measured at the inferior, mid, and superior segments in the coronal reformatted CT images. Post-traumatic SCJ expansion was evaluated in patients with rib and costal cartilage fractures. Additionally, SCJ and the presence of other post-traumatic signs were compared. An inter-observer reliability analysis with Intraclass correlation coefficient (ICC) scores with 95% CIs were calculated. 
 Results: In the presence of fractures of 1st to 4th ribs a statistically significant widening of superior and mid segments of the ipsilateral SCJs were detected. A 2-mm or greater difference of widening of the superior segment of the ipsilateral SCJ compared to the contralateral joint was found statistically significant for hemothorax, pneumothorax, and wall emphysema. The inter-observer agreement was excellent for the measurements of the SCJ on coronal plane, having an ICC score ranging from 0.921 to 0.961 (95% CI). 
 Conclusion: The expansion of the ipsilateral SCJ distances in rib fractures in the upper part of the chest wall shows that SCJ performs an important role in the absorption of energy to the chest wall.