Associated thoracic injury in patients with a clavicle fracture: a retrospective analysis of 1461 polytrauma patients.
OBJECTIVE
During primary survey the main goal is to ascertain life-threatening injuries. A chest X-ray is recommended in all polytrauma patients as thoracic injury plays an important role in mortality. However, treatment-dictating injuries are often missed on the chest X-ray. In contrast, clavicle fractures should be relatively easy to diagnose on a chest X-ray. We previously showed that clavicle fractures occur in approximately 10 % of all polytrauma patients in our population. The aim was to compare polytrauma patients, with and without a clavicle fracture, to investigate if a clavicle fracture is associated with concomitant thoracic injury.


METHODS
A retrospective cohort study of polytrauma patients (ISS ≥ 16) from 2007 until 2011. Thoracic injuries were defined as: ribfracture, pneumothorax, lung contusion, sternum fracture, hemothorax, myocardial contusion, thoracic aorta injury and thoracic spine injury.


RESULTS
Of 1461 polytrauma patients in 160 patients a clavicle fracture was diagnosed, and 95 % was diagnosed on chest X-ray. Patients with a clavicle fracture had a higher mean Injury Severity Score (ISS) (29.2 ± 10.1 vs. 24.9 ± 9.1; P < 0.001). Additional thoracic injuries were more prevalent in patients with a clavicle fracture (76 vs. 47 %; OR 3.6; 95 % CI 2.45-5.24) and they had a higher rate of thoracic injury with an AIS ≥ 3 (66 vs. 41 %; OR 2.8; 95 % CI 1.97-3.93).


CONCLUSIONS
The clavicle can be seen as the gatekeeper of the thorax. In polytrauma patients, a clavicle fracture is easily diagnosed during primary survey and may indicate underlying thoracic injury, as the rate and extent of concomitant thoracic injury are high.
Department of Trauma, University Medical Center Utrecht, Heidelberglaan 100, Suite G04.228, 3584 CX, Utrecht, The Netherlands. jjemvanlaarhoven@gmail.com.
J J E M
JJEM
van Laarhoven
Department of Trauma, University Medical Center Utrecht, Heidelberglaan 100, Suite G04.228, 3584 CX, Utrecht, The Netherlands.
F
F
Hietbrink
Department of Trauma, University Medical Center Utrecht, Heidelberglaan 100, Suite G04.228, 3584 CX, Utrecht, The Netherlands.
S
S
Ferree
Department of Trauma, University Medical Center Utrecht, Heidelberglaan 100, Suite G04.228, 3584 CX, Utrecht, The Netherlands.
A C
AC
Gunning
Utrecht Traumacenter, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
R M
RM
Houwert
Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
E M M
EMM
Verleisdonk
Department of Trauma, University Medical Center Utrecht, Heidelberglaan 100, Suite G04.228, 3584 CX, Utrecht, The Netherlands.
L P H
LPH
Leenen
D000328:Adult; D000368:Aged; D002968:Clavicle / Q000293:injuries*; D003937:Diagnosis, Differential; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers
Associated injury; Clavicle fracture; Polytrauma patient; Primary care; Thoracic injury