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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References
Jeray KJ (2007) Acute midshaft clavicular fracture. J Am Acad Orthop Surg 15(4):239–248. https://doi.org/10.5435/00124635-200704000-00007
Stahl D, Ellington M, Brennan K, Brennan M (2017) Association of ipsilateral rib fractures with displacement of midshaft clavicle fractures. J Orthop Trauma 31(4):225–228. https://doi.org/10.1097/BOT.0000000000000758
Carver TW, Milia DJ, Somberg C, Brasel K, Paul J (2015) Vital capacity helps predict pulmonary complications after rib fractures. J Trauma Acute Care Surg 79(3):413–416. https://doi.org/10.1097/TA.0000000000000744
Lin FC, Li RY, Tung YW, Jeng KC, Tsai SC (2016) Morbidity, mortality, associated injuries, and management of traumatic rib fractures. J Chin Med Assoc JCMA 79(6):329–334. https://doi.org/10.1016/j.jcma.2016.01.006
van Laarhoven J, Hietbrink F, Ferree S, Gunning AC, Houwert RM, Verleisdonk E, Leenen L (2019) Associated thoracic injury in patients with a clavicle fracture: a retrospective analysis of 1461 polytrauma patients. Eur J Trauma Emergency Surg Off Publ Eur Trauma Soc 45(1):59–63. https://doi.org/10.1007/s00068-016-0673-6
Rubin G, Peleg K, Givon A, Israel Trauma Group & Rozen N (2015). Upper extremity fractures among hospitalized road traffic accident adults. Am J Emergency Med 33(2), 250–253. Doi: https://doi.org/10.1016/j.ajem.2014.11.048
Muller SD, Al-Maiyah M, Hui AC, Adedapo AO (2005) Thoracic penetration following mid-shaft clavicular fracture. J Bone Joint Surg Br 87(4):568–570. https://doi.org/10.1302/0301-620X.87B4.15861
Ottomeyer C, Taylor BC, Isaacson M, Martinez L, Ebaugh P, French BG (2017) Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint dislocations: incidence and risk factors. Injury 48(2):469–473. https://doi.org/10.1016/j.injury.2016.12.021
Swart E, Laratta J, Slobogean G, Mehta S (2017) Operative treatment of rib fractures in flail chest injuries: a meta-analysis and cost-effectiveness analysis. J Orthop Trauma 31(2):64–70. https://doi.org/10.1097/BOT.0000000000000750
Nirula R, Allen B, Layman R, Falimirski ME, Somberg LB (2006) Rib fracture stabilization in patients sustaining blunt chest injury. Am Surg 72(4):307–309. https://doi.org/10.1177/000313480607200405
Galvagno SM Jr, Smith CE, Varon AJ, Hasenboehler EA, Sultan S, Shaefer G, To KB, Fox AD, Alley DE, Ditillo M, Joseph BA, Robinson BR, Haut ER (2016) Pain management for blunt thoracic trauma: a joint practice management guideline from the Eastern association for the surgery of trauma and trauma anesthesiology society. J Trauma Acute Care Surg 81(5):936–951. https://doi.org/10.1097/TA.0000000000001209
Bonnevie T, Gravier FE, Ducrocq A, Debeaumont D, Viacroze C, Cuvelier A, Muir JF, Tardif C (2018) Exercise testing in patients with diaphragm paresis. Respir Physiol Neurobiol 248:31–35. https://doi.org/10.1016/j.resp.2017.11.006
Ramsook AH, Molgat-Seon Y, Schaeffer MR, Wilkie SS, Camp PG, Reid WD, Romer LM, Guenette JA (2017) Effects of inspiratory muscle training on respiratory muscle electromyography and dyspnea during exercise in healthy men. J Appl Physiol 122(5):1267–1275. https://doi.org/10.1152/japplphysiol.00046.2017
Crapo RO, Morris AH, Gardner RM (1981) Reference spirometric values using techniques and equipment that meet ATS recommendations. Am Rev Respir Dis 123(6):659–664. https://doi.org/10.1164/arrd.1981.123.6.659
Mommsen P, Zeckey C, Andruszkow H, Weidemann J, Frömke C, Puljic P, van Griensven M, Frink M, Krettek C, Hildebrand F (2012) Comparison of different thoracic trauma scoring systems in regards to prediction of post-traumatic complications and outcome in blunt chest trauma. J Surg Res 176(1):239–247. https://doi.org/10.1016/j.jss.2011.09.018
Pape HC, Remmers D, Rice J, Ebisch M, Krettek C, Tscherne H (2000) Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. J Trauma 49(3):496–504. https://doi.org/10.1097/00005373-200009000-00018
Kim W, McKee MD (2008) Management of acute clavicle fractures. Orthop Clin North Am 39(4):491–vii. https://doi.org/10.1016/j.ocl.2008.05.006
Neer CS 2nd (1960) Nonunion of the clavicle. J Am Med Assoc 172:1006–1011. https://doi.org/10.1001/jama.1960.03020100014003
Ahrens PM, Garlick NI, Barber J, Tims EM, & Clavicle Trial Collaborative Group (2017). The clavicle trial: a multicenter randomized controlled trial comparing operative with nonoperative treatment of displaced midshaft clavicle fractures. J Bone Joint Surg Am 99(16), 1345–1354. Doi: https://doi.org/10.2106/JBJS.16.01112
McKee RC, Whelan DB, Schemitsch EH, & McKee MD (2012) Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am 94(8), 675–684. Doi: https://doi.org/10.2106/JBJS.J.01364
Zhao JG, Wang J, Long L (2015) Surgical versus conservative treatments for displaced midshaft clavicular fractures: a systematic review of overlapping meta-analyses. Medicine 94(26):e1057. https://doi.org/10.1097/MD.0000000000001057
Pang EQ, Zhang S, Harris A, Kamal RN (2017) Treatment trends in older adults with midshaft clavicle fractures. J Hand Surg 42(11):875–882. https://doi.org/10.1016/j.jhsa.2017.06.099
Huttunen TT, Launonen AP, Berg HE, Lepola V, Felländer-Tsai L, Mattila VM (2016) Trends in the incidence of clavicle fractures and surgical repair in Sweden: 2001–2012. J Bone Joint Surg Am 98(21):1837–1842. https://doi.org/10.2106/JBJS.15.01284
Canadian Orthopaedic Trauma Society (2007). Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 89(1): 1–10. Doi: https://doi.org/10.2106/JBJS.F.00020
Song HS, Kim H (2021) Current concepts in the treatment of midshaft clavicle fractures in adults. Clin Shoulder Elbow 24(3):189–198. https://doi.org/10.5397/cise.2021.00388
Eberbach H, Lefering R, Hager S et al (2021) Influence of surgical stabilization of clavicle fractures in multiply-injured patients with thoracic trauma. Sci Rep 11:23263. https://doi.org/10.1038/s41598-021-02771-5
Acknowledgements
Dan Eastwood, Medical College of Wisconsin Department of Biostatistics – Milwaukee, WI, USA
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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