Alexander Graf1, Derrick Wendler2, Tannor Court3, Jacob Talhelm4, Thomas Carver5, Chad Beck6, Gregory Schmeling4. 1. Department of Orthopaedic Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Ave, P.O. Box 26099, Milwaukee, WI, 53226-0099, USA. Agraf@mcw.edu. 2. WellStar Atlanta Medical Center, Atlanta, GA, USA. 3. Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA. 4. Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. 5. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. 6. Atrium Health, Rome, GA, USA.
Abstract
PURPOSE: Clavicle fractures are common in patients who sustain blunt chest trauma (BCT). Recently, surgical fixation of rib fractures in patients with BCT has been shown to improve pulmonary and clinical outcomes. Therefore, the purpose of this study is to assess the role of early clavicle fixation (ECF) versus non-operative (NO) treatment for midshaft clavicle fractures in this same population. METHODS: A retrospective chart review was performed in patients with midshaft clavicle fractures and BCT at a Level I Trauma Center between 2007 and 2017. Patients with pre-existing pulmonary conditions and head injuries necessitating mechanical ventilation were excluded. Demographic data, injury mechanisms, and Thoracic Trauma Severity Scores (TTS) were analyzed. Inpatient pulmonary outcomes were assessed with serial vital capacity (VC) measurements, intubation, mechanical ventilation, and pulmonary complications data. In addition, intensive care unit (ICU) and hospital length of stay (LOS), mortality, discharge location, and incidence of postoperative complications in the ECF group were also measured. RESULTS: Thirty-six patients underwent ECF, and 24 underwent NO treatment. The ECF cohort was statistically younger and had a greater incidence of clavicle fracture shortening than the NO group. There was no difference in pulmonary outcomes, ICU or hospital LOS, or mortality between groups. There were no complications associated with ECF. Patients who underwent ECF were more likely to discharge to home. There were no postoperative complications associated with ECF. CONCLUSION: ECF of midshaft clavicle fractures does not improve pulmonary outcomes in patients with BCT. However, despite the lack of pulmonary benefit, there appears to be no added risk of harm. Therefore, ECF is a reasonable consideration in this patient population who otherwise meet clavicle fracture operative indications.
PURPOSE: Clavicle fractures are common in patients who sustain blunt chest trauma (BCT). Recently, surgical fixation of rib fractures in patients with BCT has been shown to improve pulmonary and clinical outcomes. Therefore, the purpose of this study is to assess the role of early clavicle fixation (ECF) versus non-operative (NO) treatment for midshaft clavicle fractures in this same population. METHODS: A retrospective chart review was performed in patients with midshaft clavicle fractures and BCT at a Level I Trauma Center between 2007 and 2017. Patients with pre-existing pulmonary conditions and head injuries necessitating mechanical ventilation were excluded. Demographic data, injury mechanisms, and Thoracic Trauma Severity Scores (TTS) were analyzed. Inpatient pulmonary outcomes were assessed with serial vital capacity (VC) measurements, intubation, mechanical ventilation, and pulmonary complications data. In addition, intensive care unit (ICU) and hospital length of stay (LOS), mortality, discharge location, and incidence of postoperative complications in the ECF group were also measured. RESULTS: Thirty-six patients underwent ECF, and 24 underwent NO treatment. The ECF cohort was statistically younger and had a greater incidence of clavicle fracture shortening than the NO group. There was no difference in pulmonary outcomes, ICU or hospital LOS, or mortality between groups. There were no complications associated with ECF. Patients who underwent ECF were more likely to discharge to home. There were no postoperative complications associated with ECF. CONCLUSION: ECF of midshaft clavicle fractures does not improve pulmonary outcomes in patients with BCT. However, despite the lack of pulmonary benefit, there appears to be no added risk of harm. Therefore, ECF is a reasonable consideration in this patient population who otherwise meet clavicle fracture operative indications.
Authors: Christina Ottomeyer; Benjamin C Taylor; Mark Isaacson; Lara Martinez; Pierce Ebaugh; Bruce G French Journal: Injury Date: 2016-12-28 Impact factor: 2.586
Authors: Samuel Michael Galvagno; Charles E Smith; Albert J Varon; Erik A Hasenboehler; Shahnaz Sultan; Gregory Shaefer; Kathleen B To; Adam D Fox; Darrell E R Alley; Michael Ditillo; Bellal A Joseph; Bryce R H Robinson; Elliot R Haut Journal: J Trauma Acute Care Surg Date: 2016-11 Impact factor: 3.313
Authors: Thomas W Carver; David J Milia; Chloe Somberg; Karen Brasel; Jasmeet Paul Journal: J Trauma Acute Care Surg Date: 2015-09 Impact factor: 3.313