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Injuries of the sternoclavicular region indicate concomitant lesions and need distinguished imaging

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

Abstract

Purpose

To evaluate injuries of the sternoclavicular region as indicator injury for relevant concomitant injuries and to evaluate the modalities of initial imaging. We hypothesised a high incidence of concomitant injuries as well as a deficiency of X-ray as the initial gold standard.

Methods

We retrospectively analysed patients suffering from injuries of the sternoclavicular region between 2002 and 2017. We analysed amongst injury type and severity, initial imaging (X-ray vs. CT scan of the sternoclavicular region vs. whole-body scan), and complement of imaging with regard to defined concomitant injury localisations and the resulting necessity and urgency of surgery.

Results

We included n = 61 patients. The mean ISS was 13.5 ± 17, n = 13 (21.3%) cases were classified as “severely injured” (ISS ≥ 16). N = 29 (47.5%) achieved an initial X-ray, n = 10 (16.4%) an initial CT scan of the sternoclavicular region, and n = 22 (36%) an initial whole-body CT scan. Initial imaging correlated significantly with ISS. In n = 21 (72.4%) cases of the X-ray group a significant complement from X-ray to CT scan of the sternoclavicular region was indicated (p ≤ 0.001). N = 31 (50.8%) patients suffered from concomitant injuries. N = 39 (63.9%) of all patients underwent any kind of surgery, thereof n = 23 (37.7%) related to their sternoclavicular injuries.

Conclusion

Injuries of the sternoclavicular complex are indicators for the presence of multiple injuries. A CT scan of the sternoclavicular region including ipsilateral apex of the lung and upper rib cage comprised a large proportion of concomitant injuries. Mapping those injuries during initial imaging improves treatment process, avoids underdiagnostic, and decreases uncertainties.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Campus Innenstadt, Nußbaumstr. 20, 80336, Munich, Germany

    Tobias Helfen, Evi Fleischhacker, Wolfgang Böcker & Ben Ockert

  2. Department of Radiology, Munich University Hospital, Ludwig-Maximilians-University, Nußbaumstr. 20, 80336, Munich, Germany

    Stephan Jansen

  3. Department of Radiology, DONAUISAR Klinikum Deggendorf, Perlasberger Str. 41, 94469, Deggendorf, Germany

    Stefan Wirth

Authors
  1. Tobias Helfen
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  2. Stephan Jansen
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  3. Evi Fleischhacker
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  4. Wolfgang Böcker
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  5. Stefan Wirth
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  6. Ben Ockert
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Corresponding author

Correspondence to Tobias Helfen.

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Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

Study was approved by the local ethical board: Ludwig Maximilians University, Munich (LMU) #18-910.

Informed consent

Written informed consent was obtained from all patients.

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Helfen, T., Jansen, S., Fleischhacker, E. et al. Injuries of the sternoclavicular region indicate concomitant lesions and need distinguished imaging. Eur J Trauma Emerg Surg 47, 1399–1406 (2021). https://doi.org/10.1007/s00068-019-01178-2

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  • DOI: https://doi.org/10.1007/s00068-019-01178-2

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