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Acute clavicle fixation after blunt chest trauma: effect on pulmonary outcomes and patient disposition

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Clavicle fractures are common in patients who sustain blunt chest trauma (BCT). Recently, surgical fixation of rib fractures in patients with BCT has been shown to improve pulmonary and clinical outcomes. Therefore, the purpose of this study is to assess the role of early clavicle fixation (ECF) versus non-operative (NO) treatment for midshaft clavicle fractures in this same population.

Methods

A retrospective chart review was performed in patients with midshaft clavicle fractures and BCT at a Level I Trauma Center between 2007 and 2017. Patients with pre-existing pulmonary conditions and head injuries necessitating mechanical ventilation were excluded. Demographic data, injury mechanisms, and Thoracic Trauma Severity Scores (TTS) were analyzed. Inpatient pulmonary outcomes were assessed with serial vital capacity (VC) measurements, intubation, mechanical ventilation, and pulmonary complications data. In addition, intensive care unit (ICU) and hospital length of stay (LOS), mortality, discharge location, and incidence of postoperative complications in the ECF group were also measured.

Results

Thirty-six patients underwent ECF, and 24 underwent NO treatment. The ECF cohort was statistically younger and had a greater incidence of clavicle fracture shortening than the NO group. There was no difference in pulmonary outcomes, ICU or hospital LOS, or mortality between groups. There were no complications associated with ECF. Patients who underwent ECF were more likely to discharge to home. There were no postoperative complications associated with ECF.

Conclusion

ECF of midshaft clavicle fractures does not improve pulmonary outcomes in patients with BCT. However, despite the lack of pulmonary benefit, there appears to be no added risk of harm. Therefore, ECF is a reasonable consideration in this patient population who otherwise meet clavicle fracture operative indications.

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Acknowledgements

Dan Eastwood, Medical College of Wisconsin Department of Biostatistics – Milwaukee, WI, USA

Funding

No funding was received to assist with the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose.

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Authorship has been granted only to those individuals who have contributed substantially to the research or manuscript. This retrospective review of patient electronic medical records was reviewed by our institutional review board and was approved as exempt in accordance with the Declaration of the World Medical Association.

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Correspondence to Alexander Graf.

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Graf, A., Wendler, D., Court, T. et al. Acute clavicle fixation after blunt chest trauma: effect on pulmonary outcomes and patient disposition. Eur J Orthop Surg Traumatol 33, 1921–1927 (2023). https://doi.org/10.1007/s00590-022-03368-y

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  • DOI: https://doi.org/10.1007/s00590-022-03368-y

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