Skip to main content
Erschienen in: European Journal of Trauma and Emergency Surgery 5/2021

01.07.2019 | Original Article

Injuries of the sternoclavicular region indicate concomitant lesions and need distinguished imaging

verfasst von: Tobias Helfen, Stephan Jansen, Evi Fleischhacker, Wolfgang Böcker, Stefan Wirth, Ben Ockert

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 5/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To evaluate injuries of the sternoclavicular region as indicator injury for relevant concomitant injuries and to evaluate the modalities of initial imaging. We hypothesised a high incidence of concomitant injuries as well as a deficiency of X-ray as the initial gold standard.

Methods

We retrospectively analysed patients suffering from injuries of the sternoclavicular region between 2002 and 2017. We analysed amongst injury type and severity, initial imaging (X-ray vs. CT scan of the sternoclavicular region vs. whole-body scan), and complement of imaging with regard to defined concomitant injury localisations and the resulting necessity and urgency of surgery.

Results

We included n = 61 patients. The mean ISS was 13.5 ± 17, n = 13 (21.3%) cases were classified as “severely injured” (ISS ≥ 16). N = 29 (47.5%) achieved an initial X-ray, n = 10 (16.4%) an initial CT scan of the sternoclavicular region, and n = 22 (36%) an initial whole-body CT scan. Initial imaging correlated significantly with ISS. In n = 21 (72.4%) cases of the X-ray group a significant complement from X-ray to CT scan of the sternoclavicular region was indicated (p ≤ 0.001). N = 31 (50.8%) patients suffered from concomitant injuries. N = 39 (63.9%) of all patients underwent any kind of surgery, thereof n = 23 (37.7%) related to their sternoclavicular injuries.

Conclusion

Injuries of the sternoclavicular complex are indicators for the presence of multiple injuries. A CT scan of the sternoclavicular region including ipsilateral apex of the lung and upper rib cage comprised a large proportion of concomitant injuries. Mapping those injuries during initial imaging improves treatment process, avoids underdiagnostic, and decreases uncertainties.
Literatur
1.
Zurück zum Zitat Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elb Surg. 2002;11(5):452–6.CrossRef Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elb Surg. 2002;11(5):452–6.CrossRef
2.
Zurück zum Zitat Kirby JC, Edwards E, Kamali Moaveni A. Management and functional outcomes following sternoclavicular joint dislocation. Injury. 2015;46(10):1906–13.CrossRef Kirby JC, Edwards E, Kamali Moaveni A. Management and functional outcomes following sternoclavicular joint dislocation. Injury. 2015;46(10):1906–13.CrossRef
3.
Zurück zum Zitat Banerjee R, Waterman B, Padalecki J, Robertson W. Management of distal clavicle fractures. J Am Acad Orthop Surg. 2011;19(7):392–401.CrossRef Banerjee R, Waterman B, Padalecki J, Robertson W. Management of distal clavicle fractures. J Am Acad Orthop Surg. 2011;19(7):392–401.CrossRef
4.
Zurück zum Zitat Glass ER, Thompson JD, Cole PA, Gause TM 2nd, Altman GT. Treatment of sternoclavicular joint dislocations: a systematic review of 251 dislocations in 24 case series. J Trauma. 2011;70(5):1294–8. Glass ER, Thompson JD, Cole PA, Gause TM 2nd, Altman GT. Treatment of sternoclavicular joint dislocations: a systematic review of 251 dislocations in 24 case series. J Trauma. 2011;70(5):1294–8.
5.
Zurück zum Zitat McIntosh AL. Surgical treatment of adolescent clavicle fractures: results and complications. J Pediatr Orthop. 2016;36(Suppl 1):S41–3.CrossRef McIntosh AL. Surgical treatment of adolescent clavicle fractures: results and complications. J Pediatr Orthop. 2016;36(Suppl 1):S41–3.CrossRef
6.
Zurück zum Zitat Hubner EJ, Hausschild O, Sudkamp NP, Strohm PC. Clavicle fractures—is there a standard treatment? Acta Chir Orthop Traumatol Cech. 2011;78(4):288–96. Hubner EJ, Hausschild O, Sudkamp NP, Strohm PC. Clavicle fractures—is there a standard treatment? Acta Chir Orthop Traumatol Cech. 2011;78(4):288–96.
7.
Zurück zum Zitat Groh GI, Mighell MA, Basamania CJ, Kibler WB. All things clavicle: from acromioclavicular to sternoclavicular and all points in between. Instr Course Lect. 2016;65:181–96. Groh GI, Mighell MA, Basamania CJ, Kibler WB. All things clavicle: from acromioclavicular to sternoclavicular and all points in between. Instr Course Lect. 2016;65:181–96.
8.
Zurück zum Zitat Bakir MS, Merschin D, Unterkofler J, et al. Injuries of the medial clavicle: a cohort analysis in a Level-I-Trauma-Center. Concomitant injuries. Management. Classification. Chirurgia (Bucur). 2017;112(5):594.CrossRef Bakir MS, Merschin D, Unterkofler J, et al. Injuries of the medial clavicle: a cohort analysis in a Level-I-Trauma-Center. Concomitant injuries. Management. Classification. Chirurgia (Bucur). 2017;112(5):594.CrossRef
9.
Zurück zum Zitat Ernberg LA, Potter HG. Radiographic evaluation of the acromioclavicular and sternoclavicular joints. Clin Sports Med. 2003;22(2):255–75.CrossRef Ernberg LA, Potter HG. Radiographic evaluation of the acromioclavicular and sternoclavicular joints. Clin Sports Med. 2003;22(2):255–75.CrossRef
10.
Zurück zum Zitat Harris JD, Latshaw JC. Improved clinical utility in clavicle fracture decision-making with true orthogonal radiographs. Int J Shoulder Surg. 2012;6(4):130–4.CrossRef Harris JD, Latshaw JC. Improved clinical utility in clavicle fracture decision-making with true orthogonal radiographs. Int J Shoulder Surg. 2012;6(4):130–4.CrossRef
11.
Zurück zum Zitat Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.CrossRef Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.CrossRef
12.
Zurück zum Zitat Ferree S, van Laarhoven JJ, Houwert RM, Hietbrink F, Verleisdonk EJ, Leenen LP. Distribution and treatment of clavicular fractures in monotrauma and polytrauma patients. J Trauma Manag Outcomes. 2014;8:17.CrossRef Ferree S, van Laarhoven JJ, Houwert RM, Hietbrink F, Verleisdonk EJ, Leenen LP. Distribution and treatment of clavicular fractures in monotrauma and polytrauma patients. J Trauma Manag Outcomes. 2014;8:17.CrossRef
13.
Zurück zum Zitat Huber-Wagner S, Kanz KG, Hanschen M, van Griensven M, Biberthaler P, Lefering R. Whole-body computed tomography in severely injured patients. Curr Opin Crit Care. 2018;24(1):55–61.CrossRef Huber-Wagner S, Kanz KG, Hanschen M, van Griensven M, Biberthaler P, Lefering R. Whole-body computed tomography in severely injured patients. Curr Opin Crit Care. 2018;24(1):55–61.CrossRef
14.
Zurück zum Zitat Nettles JL, Linscheid RL. Sternoclavicular dislocations. J Trauma. 1968;8(2):158–64.CrossRef Nettles JL, Linscheid RL. Sternoclavicular dislocations. J Trauma. 1968;8(2):158–64.CrossRef
15.
Zurück zum Zitat Herzog C, Ahle H, Mack MG, et al. Traumatic injuries of the pelvis and thoracic and lumbar spine: does thin-slice multidetector-row CT increase diagnostic accuracy? Eur Radiol. 2004;14(10):1751–60.CrossRef Herzog C, Ahle H, Mack MG, et al. Traumatic injuries of the pelvis and thoracic and lumbar spine: does thin-slice multidetector-row CT increase diagnostic accuracy? Eur Radiol. 2004;14(10):1751–60.CrossRef
Metadaten
Titel
Injuries of the sternoclavicular region indicate concomitant lesions and need distinguished imaging
verfasst von
Tobias Helfen
Stephan Jansen
Evi Fleischhacker
Wolfgang Böcker
Stefan Wirth
Ben Ockert
Publikationsdatum
01.07.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 5/2021
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-019-01178-2

Weitere Artikel der Ausgabe 5/2021

European Journal of Trauma and Emergency Surgery 5/2021 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.