title: Association of scapular fractures and blunt thoracic aortic injury: fact or fiction?
abstract: It is classically taught that scapular fractures (SF) are commonly associated with blunt thoracic aortic injury (BTAI). The purpose of this study was to determine the association between SF and BTAI. A 10-year retrospective review of blunt trauma admissions from two level I trauma centers located in different geographic regions, Washington Hospital Center (WHC) and Los Angeles County Medical Center and the University of Southern California (LAC/USC), was performed. Patients with SF and BTAI were identified, and records were reviewed to determine associated injuries. We identified 35,541 blunt trauma admissions (WHC: 12,971, LAC/USC: 22,570). SF and BTAI occurred in 1.1 per cent and 0.6 per cent of patients, respectively. Most of the patients with SF had associated injuries (99%). Only four patients with SF had BTAI (4/392; 1.0%). The most common injuries associated with SF were rib (43%), lower extremity (36%), and upper extremity (33%) fractures. SF is uncommon after blunt trauma. Patients with SF almost always have significant associated injuries. Although SF indicates a high amount of energy transmitted to the upper thorax, these patients rarely have BTAI. SF should not be used as an indicator of possible BTAI.
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Los Angeles County/University of Southern California Medical Center, Los Angeles, California 90033, USA.
authors.forename: Carlos V R
authors.initials: CV
authors.lastname: Brown
authors.forename: George
authors.initials: G
authors.lastname: Velmahos
authors.forename: Dennis
authors.initials: D
authors.lastname: Wang
authors.forename: Susan
authors.initials: S
authors.lastname: Kennedy
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000293:injuries*; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D009104:Multiple Trauma / Q000453:epidemiology*; D010343:Patient Admission / Q000706:statistics & numerical data; D012540:Scapula / Q000293:injuries*; D015996:Survival Rate; D013898:Thoracic Injuries / Q000150:complications* / Q000453:epidemiology; D014193:Trauma Centers / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000453:epidemiology