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Schulz-Drost S, Spering C. [Treatment strategy for severe implosion injuries of the lateral chest wall]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:188-196. [PMID: 38273139 DOI: 10.1007/s00113-023-01406-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/27/2024]
Abstract
In the majority of cases implosion injuries to the thoracic wall are caused by blunt, massive force acting on the thorax. Basically, different regions and directions of the acting energy have to be taken into account. In common usage, the term implosion injury has become established, especially for the sequelae of lateral energy impact. Particular attention should be paid to the stability of the shoulder girdle, the underlying hemithorax and its intrathoracic organs.
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Affiliation(s)
- Stefan Schulz-Drost
- Zentrum für Bewegungs- und Altersmedizin, Helios Kliniken Schwerin, Wismarsche Str. 397, 19055, Schwerin, Deutschland.
- Klinik für Unfallchirurgie, orthopädische Chirurgie, Universitätsklinikum, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland.
| | - Christopher Spering
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
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2
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Franco H, Williamson F, Manzanero S, Schuetz M. Clavicle fixation to reduce short-term analgesia and improve respiratory function in patients with chest wall injuries. Arch Orthop Trauma Surg 2023; 143:6561-6567. [PMID: 37401951 PMCID: PMC10542300 DOI: 10.1007/s00402-023-04952-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION The objective of this study was to determine if operative fixation of clavicle fractures in patients with non-operatively treated ipsilateral rib fractures is associated with a lower overall analgesic requirement and improved respiratory function. MATERIALS AND METHODS A retrospective matched cohort study was conducted involving patients admitted to a single tertiary trauma centre having sustained a clavicle fracture with ipsilateral rib fracture/s between January 2014 and June 2020. Patients were excluded if brain, abdominal, pelvic, or lower limb trauma was identified. 31 patients with operative clavicle fixation (study group) were matched 1:1 to 31 patients with non-operative management of the clavicle fracture (control group) based on age, sex, number of rib fractures and injury severity score. The primary outcome was the number of analgesic types used, and the secondary outcome was respiratory function. RESULTS The study group required a mean of 3.50 types of analgesia prior to surgery which decreased to 1.57 post-surgery. The control group required 2.92 types of analgesia, reducing to 1.65 after the date of surgery in the study group. A General Linear Mixed Model indicated that the intervention (operative vs. non-operative management) had statistically significant effects on the number of required analgesic types (p < 0.001, [Formula: see text] = 0.365), oxygen saturation (p = 0.001, [Formula: see text] = 0.341, 95% CI 0.153-0.529) and temporal decline in daily supplemental oxygen requirement (p < 0.001, [Formula: see text] = 0.626, 95% CI 0.455-0.756). CONCLUSION This study supported the hypothesis that operative clavicle fixation reduces short-term in-patient analgesia use and improves respiratory parameters in patients with ipsilateral rib fractures. LEVEL OF EVIDENCE Level III therapeutic study.
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Affiliation(s)
- Helena Franco
- Trauma Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia.
- Royal Brisbane and Women's Hospital, Jamieson Trauma Institute, Metro North Health, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia.
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
- Orthopaedic Department, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia.
| | - Frances Williamson
- Trauma Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
- Royal Brisbane and Women's Hospital, Jamieson Trauma Institute, Metro North Health, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Emergency and Trauma Center, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
| | - Silvia Manzanero
- Royal Brisbane and Women's Hospital, Jamieson Trauma Institute, Metro North Health, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Australian Institute of Bioengineering and Nanotechnology, The University of Queensland, Brisbane, QLD, Australia
| | - Michael Schuetz
- Royal Brisbane and Women's Hospital, Jamieson Trauma Institute, Metro North Health, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Orthopaedic Department, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
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Kim KB, Lee YS, Wang SI. Clinical Outcome after Clavicular Hook Plate Fixation for Displaced Medial-End Clavicle Fractures. Clin Orthop Surg 2023; 15:843-852. [PMID: 37811514 PMCID: PMC10551687 DOI: 10.4055/cios23034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/26/2023] [Accepted: 06/21/2023] [Indexed: 10/10/2023] Open
Abstract
Background Surgery of the medial end of the clavicle remains a challenge for orthopedic surgeons. Moreover, there is no standard surgical procedure for treating displaced fractures or dislocation of the medial clavicle. Thus, the present study aimed to evaluate the safety and efficacy of using a hook plate for treating medial-end clavicular fractures and present functional outcomes. Methods We retrospectively investigated 18 patients who underwent surgery with a hook plate from July 2016 to December 2021. There were 14 men and 4 women with a mean age of 57.4 years. Fracture union was assessed at follow-up by computed tomography (CT). Other outcome parameters were complications, including implant failure, infection, nonunion, osteolysis of sternal manubrium, and migration of the hook portion. Range of motion (ROM), visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH), and American Shoulder and Elbow Society (ASES) scores were evaluated 6 months postoperatively and at the last follow-up. Results The mean operation time was 43.8 minutes (range, 35-50 minutes) and the mean follow-up was 22.8 months (range, 12-42 months). Bone union was confirmed in all cases. The mean union time was 6.2 months (range, 6-7 months). Implant removal was performed routinely according to the clinical course in 17 cases. The mean implant removal time was 10.0 months (range, 6-14 months). Clinical and functional outcomes measured at the last follow-up were significantly improved compared to those at 6 months postoperatively (p < 0.05). Regarding complications, there were 6 cases (33.3%) of osteolysis of the sternal manubrium. Although the anteroposterior length of the manubrium and hook depth showed significant differences between the non-osteolysis group and the osteolysis group (p = 0.024), ROM, VAS, Quick DASH, and ASES scores were not significantly different between the two groups (all p > 0.05). Conclusions Clavicle hook plating can be a safe and effective method that can be easily applied with good outcomes if it is used with appropriate surgical planning and technique for medial-end clavicle fracture. CT scans are useful for preoperative planning and postoperative evaluation of bone union or complications.
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Affiliation(s)
- Ki Bum Kim
- Department of Orthopaedics Surgery, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Young Sang Lee
- Department of Orthopaedics Surgery, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Sung Il Wang
- Department of Orthopaedics Surgery, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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Hoepelman RJ, van der Linde RA, Beeres FJ, Beks RB, Sweet AA, Lansink KW, van Wageningen B, Tromp TN, Minervini F, Link BC, van Veelen NM, Hoogendoorn JM, de Jong MB, van Baal MC, Leenen LP, Groenwold RH, Houwert RM, IJpma FF. In patients with combined clavicle and multiple rib fractures, does fracture fixation of the clavicle improve clinical outcomes? A multicenter prospective cohort study of 232 patients. J Trauma Acute Care Surg 2023; 95:249-255. [PMID: 37165478 PMCID: PMC10389406 DOI: 10.1097/ta.0000000000004001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Clavicle and rib fractures are often sustained concomitantly. The combination of injuries may result in decreased stability of the chest wall, making these patients prone to (respiratory) complications and prolonged hospitalization. This study aimed to assess whether adding chest wall stability by performing clavicle fixation improves clinical outcomes in patients with concurrent clavicle and rib fractures. METHODS A prospective multicenter study was performed including all adult patients admitted between January 2018 and March 2021 with concurrent ipsilateral clavicle and rib fractures. Patients treated operatively versus nonoperatively for their clavicle fracture were matched using propensity score matching. The primary outcome was hospital length of stay (HLOS). Secondary outcomes were intensive care unit length of stay, duration of mechanical ventilation, pain, complications, and quality of life at 6 weeks and 12 months of follow-up. RESULTS In total, 232 patients with concomitant ipsilateral clavicle and rib fractures were included. Fifty-two patients (22%) underwent operative treatment of which 39 could be adequately matched to 39 nonoperatively treated patients. No association was observed between clavicle plate fixation and HLOS (mean difference, 2.3 days; 95% confidence interval, -2.1 to 6.8; p = 0.301) or any secondary endpoint. Eight of the 180 nonoperatively treated patients (4%) had a symptomatic nonunion, for which 5 underwent secondary clavicle fixation. CONCLUSION We found no evidence that, in patients with combined clavicle and multiple rib fractures, plate fixation of the clavicle reduces HLOS, pain, or (pulmonary) complications, nor that it improves quality of life. STUDY TYPE Therapeutic/Care Management; Level III.
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Zhang D, Jiao C, Xi S, Wang L, Li R, Zhang Q. Evaluation of surgical outcomes in elderly patients with rib fractures: A single-centre propensity score matching study. Front Surg 2023; 10:1174365. [PMID: 37143770 PMCID: PMC10151702 DOI: 10.3389/fsurg.2023.1174365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 03/31/2023] [Indexed: 05/06/2023] Open
Abstract
Background Rib fractures are the most common injuries in chest trauma. Compared with younger patients, elderly patients with rib fracture have a higher incidence of complications and mortality. A retrospective study was conducted to investigate the effect of internal fixation compared with conservative treatment on the outcome of rib fracture in elderly patients. Material and methods We used a 1:1 propensity score matching method to perform a retrospective analysis of 703 elderly patients with rib fractures treated in the Thoracic Surgery Department of Beijing Jishuitan Hospital between 2013 and 2020. After matching, the length of hospital stay, death, symptom relief and rib fracture healing were compared between the surgery and the control group. Results The study included 121 patients receiving SSRF in the surgery group and 121 patients receiving conservative treatment in the control group. The length of hospital stay in the surgery group was significantly longer than that in the conservative group (11.39d vs. 9.48d, p = 0.000). After 9 months of follow-up, the fracture healing rate in the surgery group was significantly higher than that in the control group (96.67% vs. 88.89%, p = 0.020). The fracture healing time (p = 0.000), improvement in pain score (p = 0.000) and duration of pain medication use (p = 0.000) were also significantly better in the surgery group than in the control group. Conclusion Compared with conservative treatment, surgical treatment can prolong hospital stay to some extent. However, it has the advantages of more rapid healing and lessened pain. For rib fractures in elderly individuals, surgical treatment is a safe and effective option under strict surgical indications and is recommended.
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Affiliation(s)
- Dong Zhang
- Department of Thoracic Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Chenbo Jiao
- Health Science Center, Peking University, Beijing, China
| | - Siqi Xi
- Health Science Center, Peking University, Beijing, China
| | - Langran Wang
- Health Science Center, Peking University, Beijing, China
| | - Run Li
- Health Science Center, Peking University, Beijing, China
| | - Qiang Zhang
- Department of Thoracic Surgery, Beijing Jishuitan Hospital, Beijing, China
- Correspondence: Qiang Zhang
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Influence of surgical stabilization of clavicle fractures in multiply-injured patients with thoracic trauma. Sci Rep 2021; 11:23263. [PMID: 34853398 PMCID: PMC8636561 DOI: 10.1038/s41598-021-02771-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 11/22/2021] [Indexed: 12/13/2022] Open
Abstract
Thoracic trauma has decisive influence on the outcome of multiply-injured patients and is often associated with clavicle fractures. The affected patients are prone to lung dysfunction and multiple organ failure. A multi-center, retrospective analysis of patient records documented in the TraumaRegister DGU was performed to assess the influence of surgical stabilization of clavicle fractures in patients with thoracic trauma. A total of 3,209 patients were included in the analysis. In 1362 patients (42%) the clavicle fracture was treated operatively after 7.1 ± 5.3 days. Surgically treated patients had a significant reduction in lung failure (p = 0.013, OR = 0.74), multiple organ failure (p = 0.001, OR = 0.64), intubation time (p = 0.004; -1.81 days) and length of hospital stay (p = 0.014; -1.51 days) compared to non-operative treatment. Moreover, surgical fixation of the clavicle within five days following hospital admission significantly reduced the rates of lung failure (p = 0.01, OR = 0.62), multiple organ failure (p = 0.01, OR = 0.59) and length of hospital stay (p = 0.01; -2.1 days). Based on our results, multiply-injured patients with thoracic trauma and concomitant clavicle fracture may benefit significantly from surgical stabilization of a clavicle fracture, especially when surgery is performed within the first five days after hospital admission.
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7
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Bakir MS, Langenbach A, Pinther M, Lefering R, Krinner S, Grosso M, Ekkernkamp A, Schulz-Drost S. The significance of a concomitant clavicle fracture in flail chest patients: incidence, concomitant injuries, and outcome of 12,348 polytraumata from the TraumaRegister DGU ®. Eur J Trauma Emerg Surg 2021; 48:3623-3634. [PMID: 34739544 PMCID: PMC9532310 DOI: 10.1007/s00068-021-01819-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022]
Abstract
Purpose Isolated clavicle fractures (CF) rarely show complications, but their influence in the thorax trauma of the seriously injured still remains unclear. Some authors associate CF with a higher degree of chest injuries; therefore, the clavicle is meant to be a gatekeeper of the thorax. Methods A retrospective analysis of the TraumaRegister DGU® (project 2017-10) was carried out involving the years 2009–2016 (ISS ≥ 16, primary admission to a trauma center). Cohort formation: unilateral and bilateral flail chest injuries (FC), respectively, with and without a concomitant CF. Results 73,141 patients (26.5% female) met the inclusion criteria and 12,348 had flail chest injuries (FC; 20.0% CF; 67.7% monolateral FC), 25,425 other rib fractures (17.7% CF), and 35,368 had no rib fractures (6.5% CF). On average, monolateral FC patients were 56.0 ± 17.9 years old and bilateral FC patients were 57.7 ± 19 years old. The ISS in unilateral and bilateral FC were 29.1 ± 11.7 and 42.2 ± 12.9 points, respectively. FC with a CF occurred more frequently with bicycle and motorbike injuries in monolateral FC and pedestrians in bilateral FC injuries and less frequently due to falls. Patients with a CF in addition to a FC had longer hospital and ICU stays, underwent artificially respiration for longer periods, and died less often than patients without a CF. The effects were highly significant in bilateral FC. CF indicates more relevant concomitant injuries of the lung, scapula, and spinal column. Moreover, CF was associated with more injuries of the extremities in monolateral CF. Conclusion Due to the relevance of a concomitant CF fracture in FC, diagnostics should focus on finding CFs or rule them out. Combined costoclavicular injuries are associated with a significantly higher degree of thoracic injuries and longer hospital stays.
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Affiliation(s)
- Mustafa Sinan Bakir
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany. .,Department for Trauma Surgery and Orthopaedics, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Germany.
| | - Andreas Langenbach
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany.,Department of Orthopaedics and Trauma Surgery, Klinikum Forchheim, Krankenhausstraße 10, 91301, Forchheim, Germany
| | - Melina Pinther
- Department for Trauma Surgery and Orthopaedics, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Germany
| | - Rolf Lefering
- Department of Medicine, Institute for Research in Operative Medicine (IFOM), Faculty of Health, Universität Witten-Herdecke, Ostmerheimer Straße 200, 51109, Cologne, Germany
| | - Sebastian Krinner
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany
| | - Marco Grosso
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany
| | - Axel Ekkernkamp
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.,Department for Trauma Surgery and Orthopaedics, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Germany
| | - Stefan Schulz-Drost
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany.,Department for Trauma Surgery and Orthopaedics, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Germany.,Department for Trauma Surgery, Helios Hospital Schwerin, Wismarsche Strasse 393-397, 19049, Schwerin, Germany
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Sweet AAR, Beks RB, IJpma FFA, de Jong MB, Beeres FJP, Leenen LPH, Houwert RM, van Baal MCPM. Epidemiology of combined clavicle and rib fractures: a systematic review. Eur J Trauma Emerg Surg 2021; 48:3513-3520. [PMID: 34075434 PMCID: PMC9532289 DOI: 10.1007/s00068-021-01701-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022]
Abstract
Purpose The aim of this systematic review was to provide an overview of the incidence of combined clavicle and rib fractures and the association between these two injuries. Methods A systematic literature search was performed in the MEDLINE, EMBASE, and CENTRAL databases on the 14th of August 2020. Outcome measures were incidence, hospital length of stay (HLOS), intensive care unit admission and length of stay (ILOS), duration of mechanical ventilation (DMV), mortality, chest tube duration, Constant–Murley score, union and complications. Results Seven studies with a total of 71,572 patients were included, comprising five studies on epidemiology and two studies on treatment. Among blunt chest trauma patients, 18.6% had concomitant clavicle and rib fractures. The incidence of rib fractures in polytrauma patients with clavicle fractures was 56–60.6% versus 29% in patients without clavicle fractures. Vice versa, 14–18.8% of patients with multiple rib fractures had concomitant clavicle fractures compared to 7.1% in patients without multiple rib fractures. One study reported no complications after fixation of both injuries. Another study on treatment, reported shorter ILOS and less complications among operatively versus conservatively treated patients (5.4 ± 1.5 versus 21 ± 13.6 days). Conclusion Clavicle fractures and rib fractures are closely related in polytrauma patients and almost a fifth of all blunt chest trauma patients sustain both injuries. Definitive conclusions could not be drawn on treatment of the combined injury. Future research should further investigate indications and benefits of operative treatment of this injury. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-021-01701-4.
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Affiliation(s)
- Arthur A R Sweet
- Department of Surgery, University Medical Center Utrecht, 85500, 3508 GA, Utrecht, The Netherlands.
| | - Reinier B Beks
- Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Frank F A IJpma
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Mirjam B de Jong
- Department of Surgery, University Medical Center Utrecht, 85500, 3508 GA, Utrecht, The Netherlands
| | - Frank J P Beeres
- Department of Orthopedics and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland
| | - Luke P H Leenen
- Department of Surgery, University Medical Center Utrecht, 85500, 3508 GA, Utrecht, The Netherlands
| | - Roderick M Houwert
- Department of Surgery, University Medical Center Utrecht, 85500, 3508 GA, Utrecht, The Netherlands
| | - Mark C P M van Baal
- Department of Surgery, University Medical Center Utrecht, 85500, 3508 GA, Utrecht, The Netherlands
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Bakir MS, Lefering R, Haralambiev L, Kim S, Ekkernkamp A, Gümbel D, Schulz-Drost S. Acromioclavicular and sternoclavicular joint dislocations indicate severe concomitant thoracic and upper extremity injuries in severely injured patients. Sci Rep 2020; 10:21606. [PMID: 33303859 PMCID: PMC7730423 DOI: 10.1038/s41598-020-78754-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/26/2020] [Indexed: 11/09/2022] Open
Abstract
Preliminary studies show that clavicle fractures (CF) are known as an indicator in the severely injured for overall injury severity that are associated with relevant concomitant injuries in the thorax and upper extremity. In this regard, little data is available for the rarer injuries of the sternoclavicular and acromioclavicular joints (SCJ and ACJ, respectively). Our study will answer whether clavicular joint injuries (CJI), by analogy, have a similar relevance for the severely injured. We performed an analysis from the TraumaRegister DGU (TR-DGU). The inclusion criterion was an Injury Severity Score (ISS) of at least 16. In the TR-DGU, the CJI were registered as one entity. The CJI group was compared with the CF and control groups (those without any clavicular injuries). Concomitant injuries were distinguished using the Abbreviated Injury Scale according to their severity. The inclusion criteria were met by n = 114,595 patients. In the case of CJI, n = 1228 patients (1.1%) were found to be less severely injured than the controls in terms of overall injury severity. Compared to the CF group (n = 12,030; 10.5%) with higher ISS than the controls, CJI cannot be assumed as an indicator for a more severe trauma; however, CF can. Concomitant injuries were more common for severe thoracic and moderate upper extremity injuries than other body parts for CJI. This finding confirms our hypothesis that CJI could be an indicator of further specific severe concomitant injuries. Despite the rather lower relevance of the CJI in the cohort of severely injured with regard to the overall injury severity, these injuries have their importance in relation to the indicator effect for thoracic concomitant injuries and concomitant injuries of the upper extremity. A limitation is the collective registration of SCJ and ACJ injuries as one entity in the TR-DGU. A distorted picture of the CJI in favor of ACJ injuries could arise from the significantly higher incidence of the ACJ dislocation compared to the SCJ. Therefore, these two injury entities should be recorded separately in the future, and prospective studies should be carried out in order to derive a standardized treatment strategy for the care of severely injured with the respective CJI.
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Affiliation(s)
- M Sinan Bakir
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany. .,Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683, Berlin, Germany.
| | - Rolf Lefering
- Faculty of Health, IFOM - Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str.200, Haus 38, 51109, Cologne, Germany
| | - Lyubomir Haralambiev
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.,Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683, Berlin, Germany
| | - Simon Kim
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Axel Ekkernkamp
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.,Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683, Berlin, Germany
| | - Denis Gümbel
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.,Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683, Berlin, Germany
| | - Stefan Schulz-Drost
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683, Berlin, Germany.,Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany.,Department of Trauma Surgery, Helios Hospital Schwerin, Wismarsche Str. 393-397, 19049, Schwerin, Germany
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10
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Bakir MS, Unterkofler J, Hönning A, Haralambiev L, Kim S, Ekkernkamp A, Schulz-Drost S. Shoulder girdle injuries involving the medial clavicle differ from lateral clavicle injuries with a focus on concomitant injuries and management strategies: A retrospective study based on nationwide routine data. PLoS One 2019; 14:e0224370. [PMID: 31652299 PMCID: PMC6814233 DOI: 10.1371/journal.pone.0224370] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/13/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction Although shoulder girdle injuries are frequent, those of the medial part are widely unexplored. Our aim is to improve the knowledge of this rare injury and its management in Germany by big data analysis. Methods The data are based on ICD-10 codes of all German hospitals as provided by the German Federal Statistical Office. Based on the ICD-10 codes S42.01 (medial clavicle fracture, MCF) and S43.2 (sternoclavicular joint dislocation, SCJD), anonymized patient data from 2012 to 2014 were evaluated retrospectively for epidemiologic issues. We analyzed especially the concomitant injuries and therapy strategies. Results A total of 114,003 cases with a clavicle involving shoulder girdle injury were identified with 12.5% of medial clavicle injuries (MCI). These were accompanied by concomitant injuries, most of which were thoracic and craniocerebral injuries as well as injuries at the shoulder/upper arm. A significant difference between MCF and SCJD concerning concomitant injuries only appears for head injuries (p = 0.003). If MCI is the main diagnosis, soft tissue injuries typically occur as secondary diagnoses. The MCI are significantly more often associated with concomitant injuries (p < 0.001) for almost each anatomic region compared with lateral clavicle injuries (LCI). The main differences were found for thoracic and upper extremity injuries. Different treatment strategies were used, most frequently plate osteosynthesis in more than 50% of MCF cases. Surgery on SCJD was performed with K-wires, tension flange or absorbable materials, fewer by plate osteosynthesis. Conclusions We proved that MCI are rare injuries, which might be why they are treated by inhomogeneous treatment strategies. No standard procedure has yet been established. MCI can occur in cases of severely injured patients, often associated with severe thoracic or other concomitant injuries. Therefore, MCI appear to be more complex than LCI. Further studies are required regarding the development of standard treatment strategy and representative clinical studies.
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Affiliation(s)
- M. Sinan Bakir
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
- * E-mail:
| | - Jan Unterkofler
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
- Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Alexander Hönning
- Center of Clinical Science, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Lyubomir Haralambiev
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Simon Kim
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Axel Ekkernkamp
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Stefan Schulz-Drost
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Erlangen, Bayern, Germany
- Department of Trauma, Orthopedic and Hand Surgery, Helios Hospital Schwerin, Schwerin, Mecklenburg-Vorpommern, Germany
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11
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[Injuries of the posterior and lateral chest wall-importance of an additional clavicular fracture]. Unfallchirurg 2019; 121:615-623. [PMID: 30043074 DOI: 10.1007/s00113-018-0528-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Flail chest wall injuries (FCI) are common in younger patients due to high-speed trauma and in older patients due to low-energy trauma or falls from a low height. They show a high incidence of concomitant injuries and are therefore associated with high morbidity and mortality. If there is also an ipsilateral clavicular fracture (CF), the outcome is significantly poorer. The skeleton of the shoulder and chest loses stability and can lead to a loss of function of the shoulder and a pronounced deformation of the chest wall. OBJECTIVE This article shows the origin and clinical importance of FCI. What importance does a concomitant ipsilateral CF have and how can these costoclavicular injuries (CCI) be managed conservatively and operatively? MATERIAL AND METHODS After primary emergency care of the patients with appropriate diagnostics, in the presence of CCI operative stabilization was carried out by means of locked plate osteosynthesis of the clavicle and the affected ribs via minimally invasive approaches with the patient under general anesthesia. Patients were followed up postoperatively. Various minimally invasive posterolateral approaches to the chest wall were previously performed in a corpse study and then put into practice. RESULTS AND CONCLUSION This study presents therapeutic options for the reconstruction of the chest wall based on the established literature and clinical examples. An ipsilateral CF combined with fractures of the 2nd-4th ribs can be treated through an innovative clavipectoral approach. For the other fractures, standard approaches to the anterolateral and posterolateral chest wall are performed, which are associated with a good outcome in clinical practice. An operative stabilization should be performed at the latest when FCI or CCI together with a dislocating fracture and a marked deformation of the thoracic wall are present. Remaining misalignments are associated with a simultaneous loss of function of the chest wall and shoulder.
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12
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Wycech J, Fokin AA, Puente I. Evaluation of patients with surgically stabilized rib fractures by different scoring systems. Eur J Trauma Emerg Surg 2018; 46:441-445. [PMID: 30132024 DOI: 10.1007/s00068-018-0999-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/20/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Surgical Stabilization (SSRF) is gaining popularity as an alternative to non-operative management (NOM) of patients with rib fractures, however, there are no established guidelines for patients' quantifiable evaluation and for SSRF recommendation. Known rib scoring systems include: Rib Fracture Score (RFS), Chest Wall Trauma Score (CWTS), Chest Trauma Score (CTS) and RibScore (RS), but are underutilized. The purpose was to provide values of scoring systems in SSRF and NOM patients and correlate them with treatment assignment. METHODS Retrospective cohort study included 87 SSRF and 87 propensity matched NOM patients from two level-1 trauma centers. Clinical variables and score values were compared between two groups. RESULTS SSRF compared to NOM patients had significantly higher number of total rib fractures, displaced fractures, rates of pulmonary contusion and flail chest. RS and CTS values were significantly higher in SSRF compared to NOM patients (2.3 vs. 1.7, p = 0.001; 5.8 vs. 5.3, p = 0.005, respectively), but RFS and CWTS were similar. CONCLUSIONS Application of scoring systems could help with patients' objective and standardized assessment and may aid in treatment decisions. RibScore was superior to other scoring systems.
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Affiliation(s)
- Joanna Wycech
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.,Division of Trauma and Critical Care Services, Broward Health Medical Center, 1600 S Andrews Ave, Fort Lauderdale, FL, 33316, USA
| | - Alexander Alexei Fokin
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.
| | - Ivan Puente
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.,Division of Trauma and Critical Care Services, Broward Health Medical Center, 1600 S Andrews Ave, Fort Lauderdale, FL, 33316, USA.,Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA.,Department of Surgery, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
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Berninger MT, Kellermann F, Woltmann A, Bühren V, Lang M. [Single-port VATS-assisted internal fixation of serial rib fractures]. Unfallchirurg 2018; 121:335-338. [PMID: 29500508 DOI: 10.1007/s00113-018-0471-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article describes the operative stabilization of a flail chest due to traumatic serial rib fractures with extensive chest wall deformation and respiratory insufficiency. Initial conservative treatment including systemic and regional pain management and non-invasive positive pressure ventilation did not improve the pain or ventilation. Therefore, a single-port video-assisted thoracoscopic surgery (VATS) assisted internal fixation of the ribs was performed. The thoracoscopy enabled easy repositioning of the ribs and additionally an estimation of intrathoracic injuries.
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Affiliation(s)
- M T Berninger
- BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau am Staffelsee, Deutschland.
| | - F Kellermann
- BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau am Staffelsee, Deutschland
| | - A Woltmann
- BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau am Staffelsee, Deutschland
| | - V Bühren
- BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau am Staffelsee, Deutschland
| | - M Lang
- BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau am Staffelsee, Deutschland
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