Association of Ipsilateral Rib Fractures With Displacement of Midshaft Clavicle Fractures.
OBJECTIVE
To determine whether the presence of ipsilateral rib fractures affects the rate of a clavicle fracture being unstable (>100% displacement).


METHODS
A retrospective review from 2002-2013 performed at a single level 1 trauma center evaluated 243 midshaft clavicle fractures.


METHODS
Single Level 1 trauma center.


METHODS
These fractures were subdivided into those with ipsilateral rib fractures (CIR; n = 149) and those without ipsilateral rib fractures (CnIR; n = 94).


METHODS
The amount of displacement was measured on the initial injury radiograph and subsequent follow-up radiographs.


METHODS
Fractures were classified into either <100% displacement or >100% displacement, based on anteroposterior radiographs. Ipsilateral rib fractures were recorded based on which number rib was fractured and the total number of fractured ribs.


RESULTS
One hundred sixteen (78%) of the CIR group and 51 (54%) of the CnIR group were found to have >100% displacement at follow-up (P = 0.0047). Seventy-two percent of the CIR group demonstrated progression from <100% to >100% displacement of the fracture compared with only 54% of the CnIR group (P < 0.05). The odds ratio for progression of the clavicle fracture to >100% was 4.08 (P = 0.000194) when ribs 1-4 were fractured and not significant for rib fractures 5-8 or 9-12.


CONCLUSIONS
The presence of concomitant ipsilateral rib fractures significantly increases the rate of midshaft clavicle fractures being >100% displaced. In addition, a fracture involving the upper one-third of the ribs significantly increases the rate of the clavicle fracture being >100% displaced on early follow-up. Clavicle fractures with associated ipsilateral rib fractures tend to demonstrate an increased amount of displacement on follow-up radiographs compared with those without ipsilateral rib fractures.


METHODS
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Scott & White Healthcare, Temple, TX.
Daniel
D
Stahl
Matthew
M
Ellington
Kindyle
K
Brennan
Michael
M
Brennan
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012253:Rib Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D012307:Risk Factors; D017678:Sex Distribution; D000070599:Shoulder Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D013781:Texas; D055815:Young Adult