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Associated thoracic injury in patients with a clavicle fracture: a retrospective analysis of 1461 polytrauma patients

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

During primary survey the main goal is to ascertain life-threatening injuries. A chest X-ray is recommended in all polytrauma patients as thoracic injury plays an important role in mortality. However, treatment-dictating injuries are often missed on the chest X-ray. In contrast, clavicle fractures should be relatively easy to diagnose on a chest X-ray. We previously showed that clavicle fractures occur in approximately 10 % of all polytrauma patients in our population. The aim was to compare polytrauma patients, with and without a clavicle fracture, to investigate if a clavicle fracture is associated with concomitant thoracic injury.

Methods

A retrospective cohort study of polytrauma patients (ISS ≥ 16) from 2007 until 2011. Thoracic injuries were defined as: ribfracture, pneumothorax, lung contusion, sternum fracture, hemothorax, myocardial contusion, thoracic aorta injury and thoracic spine injury.

Results

Of 1461 polytrauma patients in 160 patients a clavicle fracture was diagnosed, and 95 % was diagnosed on chest X-ray. Patients with a clavicle fracture had a higher mean Injury Severity Score (ISS) (29.2 ± 10.1 vs. 24.9 ± 9.1; P < 0.001). Additional thoracic injuries were more prevalent in patients with a clavicle fracture (76 vs. 47 %; OR 3.6; 95 % CI 2.45–5.24) and they had a higher rate of thoracic injury with an AIS ≥ 3 (66 vs. 41 %; OR 2.8; 95 % CI 1.97–3.93).

Conclusions

The clavicle can be seen as the gatekeeper of the thorax. In polytrauma patients, a clavicle fracture is easily diagnosed during primary survey and may indicate underlying thoracic injury, as the rate and extent of concomitant thoracic injury are high.

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Authors and Affiliations

  1. Department of Trauma, University Medical Center Utrecht, Heidelberglaan 100, Suite G04.228, 3584 CX, Utrecht, The Netherlands

    J. J. E. M. van Laarhoven, F. Hietbrink, S. Ferree, A. C. Gunning & L. P. H. Leenen

  2. Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands

    E. M. M. Verleisdonk

  3. Utrecht Traumacenter, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    R. M. Houwert

Authors
  1. J. J. E. M. van Laarhoven
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  2. F. Hietbrink
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  3. S. Ferree
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  4. A. C. Gunning
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  5. R. M. Houwert
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  6. E. M. M. Verleisdonk
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  7. L. P. H. Leenen
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Corresponding author

Correspondence to J. J. E. M. van Laarhoven.

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Conflict of interest

All authors, Jacqueline JEM van Laarhoven, Falco Hietbrink, Steven Ferree, Amy C Gunning, R Marijn Houwert, EgbertJan MM Verleisdonk, Luke PH Leenen, declare that they have no conflict of interest.

This research was performed according to local protocol of the IRB medical ethical standards. Which does not involve informed consent for encoded patient data. Therefore approval by an ethics committee was not applicable.

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van Laarhoven, J.J.E.M., Hietbrink, F., Ferree, S. et al. Associated thoracic injury in patients with a clavicle fracture: a retrospective analysis of 1461 polytrauma patients. Eur J Trauma Emerg Surg 45, 59–63 (2019). https://doi.org/10.1007/s00068-016-0673-6

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  • DOI: https://doi.org/10.1007/s00068-016-0673-6

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