J J E M van Laarhoven1, F Hietbrink2, S Ferree2, A C Gunning2, R M Houwert3, E M M Verleisdonk4, L P H Leenen2. 1. Department of Trauma, University Medical Center Utrecht, Heidelberglaan 100, Suite G04.228, 3584 CX, Utrecht, The Netherlands. jjemvanlaarhoven@gmail.com. 2. Department of Trauma, University Medical Center Utrecht, Heidelberglaan 100, Suite G04.228, 3584 CX, Utrecht, The Netherlands. 3. Utrecht Traumacenter, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. 4. Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
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.
PURPOSE: During primary survey the main goal is to ascertain life-threatening injuries. A chest X-ray is recommended in all polytraumapatients 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 polytraumapatients in our population. The aim was to compare polytraumapatients, with and without a clavicle fracture, to investigate if a clavicle fracture is associated with concomitant thoracic injury. METHODS: A retrospective cohort study of polytraumapatients (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 polytraumapatients 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 polytraumapatients, 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.
Authors: M Sinan Bakir; Rolf Lefering; Lyubomir Haralambiev; Simon Kim; Axel Ekkernkamp; Denis Gümbel; Stefan Schulz-Drost Journal: Sci Rep Date: 2020-12-10 Impact factor: 4.379
Authors: Mustafa Sinan Bakir; Andreas Langenbach; Melina Pinther; Rolf Lefering; Sebastian Krinner; Marco Grosso; Axel Ekkernkamp; Stefan Schulz-Drost Journal: Eur J Trauma Emerg Surg Date: 2021-11-05 Impact factor: 2.374
Authors: Arthur A R Sweet; Reinier B Beks; Frank F A IJpma; Mirjam B de Jong; Frank J P Beeres; Luke P H Leenen; Roderick M Houwert; Mark C P M van Baal Journal: Eur J Trauma Emerg Surg Date: 2021-06-01 Impact factor: 2.374