title: Distribution and treatment of clavicular fractures in monotrauma and polytrauma patients.
abstract: BACKGROUND
  Although extensive research for the optimal treatment of clavicle fractures has been performed, comparative studies between monotrauma and polytrauma patients are lacking.
  
  
  OBJECTIVE
  To compare fracture distribution and treatment in monotrauma and polytrauma patients with a clavicle fracture.
  
  
  METHODS
  Single center retrospective cohort study. Fractures were classified by the Robinson classification. Monotrauma patients sustained only a clavicle fracture or a clavicle fracture plus a minor abrasion, hematoma, or superficial skin lesion leading to an Injury Severity Score (ISS) of 4 or 5 respectively. Polytrauma patients had an ISS ≥16 as a result of injury in 2 or more Abbreviated Injury Scale (AIS) regions.
  
  
  RESULTS
  154 monotrauma and 155 polytrauma patients with a clavicle fracture were identified. Monotrauma patients had a higher incidence of Type IIB fractures (displaced midshaft) compared to polytrauma patients (P = 0.002). No difference was observed regarding Type I (medial) and Type III (lateral) fractures. In monotrauma patients, Type IIB fractures were treated operatively more frequently (P = 0.004). The initial treatment for Type I and Type III fractures did not differ between monotrauma and polytrauma patients.
  
  
  CONCLUSIONS
  Monotrauma patients had a higher incidence of displaced midshaft clavicle fractures compared to polytrauma patients, and monotrauma patients with displaced midshaft clavicle fractures were treated operatively more frequently. No differences were found in the distribution and treatment of medial and lateral clavicle fractures.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Steven
authors.initials: S
authors.lastname: Ferree
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Jacqueline Jem
authors.initials: JJ
authors.lastname: van Laarhoven
authors.affiliation: Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands.
authors.forename: R Marijn
authors.initials: RM
authors.lastname: Houwert
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Falco
authors.initials: F
authors.lastname: Hietbrink
authors.affiliation: Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands.
authors.forename: Egbert Jan Mm
authors.initials: EJ
authors.lastname: Verleisdonk
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Luke Ph
authors.initials: LP
authors.lastname: Leenen