title: Fracture of the shoulder girdle in multiply injured patients - an imperative for a high level of suspicion for associated neurovascular injuries.
abstract: BACKGROUND
  The combination of a bony injury to the shoulder girdle and damage to the brachial plexus and the subclavian vessels is a rare finding. The cases of this combined injury pattern described in the literature are most notably reported in multiply-injured patients after high velocity trauma.
  
  
  RESULTS
  Three cases were admitted to our hospital after motorcycle accidents resulting in a combination of severe bony injuries to the shoulder girdle, to the subclavian artery and a lesion to the brachial plexus. Based on these three clinical cases the patterns of injury, as well as primary and secondary treatment approaches are presented.
  
  
  CONCLUSIONS
  The early detection of these injuries can be difficult in given acute, life threatening injuries addressed first in these multiply injured patients. A high level of suspicion, in conjunction with standardized ATLS based institutional protocols for secondary and tertiary survey, should increase the likelihood of a timely detection and early management of these rare but potentially devastating injuries.
authors.affiliation: Department of Orthopaedic and Reconstructive Surgery, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12003 Berlin, Germany. senat.krasnici@charite.de.
authors.forename: Senat
authors.initials: S
authors.lastname: Krasnici
authors.forename: Jörg
authors.initials: J
authors.lastname: Schmidt
authors.forename: Kolja
authors.initials: K
authors.lastname: Reimann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Ertel
authors.forename: Tobias
authors.initials: T
authors.lastname: Topp