Acromioclavicular and sternoclavicular joint dislocations indicate severe concomitant thoracic and upper extremity injuries in severely injured patients

Abstract

Preliminary studies show that clavicle fractures (CF) are known as an indicator in the severely injured for overall injury severity that are associated with relevant concomitant injuries in the thorax and upper extremity. In this regard, little data is available for the rarer injuries of the sternoclavicular and acromioclavicular joints (SCJ and ACJ, respectively). Our study will answer whether clavicular joint injuries (CJI), by analogy, have a similar relevance for the severely injured. We performed an analysis from the TraumaRegister DGU (TR-DGU). The inclusion criterion was an Injury Severity Score (ISS) of at least 16. In the TR-DGU, the CJI were registered as one entity. The CJI group was compared with the CF and control groups (those without any clavicular injuries). Concomitant injuries were distinguished using the Abbreviated Injury Scale according to their severity. The inclusion criteria were met by n = 114,595 patients. In the case of CJI, n = 1228 patients (1.1%) were found to be less severely injured than the controls in terms of overall injury severity. Compared to the CF group (n = 12,030; 10.5%) with higher ISS than the controls, CJI cannot be assumed as an indicator for a more severe trauma; however, CF can. Concomitant injuries were more common for severe thoracic and moderate upper extremity injuries than other body parts for CJI. This finding confirms our hypothesis that CJI could be an indicator of further specific severe concomitant injuries. Despite the rather lower relevance of the CJI in the cohort of severely injured with regard to the overall injury severity, these injuries have their importance in relation to the indicator effect for thoracic concomitant injuries and concomitant injuries of the upper extremity. A limitation is the collective registration of SCJ and ACJ injuries as one entity in the TR-DGU. A distorted picture of the CJI in favor of ACJ injuries could arise from the significantly higher incidence of the ACJ dislocation compared to the SCJ. Therefore, these two injury entities should be recorded separately in the future, and prospective studies should be carried out in order to derive a standardized treatment strategy for the care of severely injured with the respective CJI.

Monopolar and Bipolar Combination Injuries of the Clavicle: Retrospective Incidence Analysis and Proposal of a New Classification System

“…This finding coincides with preliminary examinations that suggest and have proven a high proportion of clavicular in addition to further additional injuries in general in MCI [24,34,35]. In a current registry study, more than every 10th case of a clavicle joint injury (SCJ and ACJ) in severely injured patients had an additional CF, a finding that is quite similar to our data [36]. This collective showed that 0.1% of all patients altogether were affected by a CCI [36].…”

“…In a current registry study, more than every 10th case of a clavicle joint injury (SCJ and ACJ) in severely injured patients had an additional CF, a finding that is quite similar to our data [36]. This collective showed that 0.1% of all patients altogether were affected by a CCI [36]. Therefore, especially in everyday clinical practice, it is essential to further exclude contra-polar injuries, especially in the case of an injury in the sternoclavicular region but also in the case of any clavicular injury [15,37].…”

Reliability of Upright Chest Radiography as a Diagnostic Screening Tool for Acromioclavicular Joint Dislocations

“…3 Patients with polytrauma have a high prevalence of shoulder injuries of up to 28%, with 3% consisting of ACJ injuries, that are associated with severe thoracic injuries. 1,2 Data are reported as mean ± SD unless otherwise indicated. Boldface P values indicate a statistically significant difference between groups (P < .05).…”

“…Patients with polytrauma have a high prevalence of shoulder injuries of up to 28%, with 3% consisting of ACJ injuries, that are associated with severe thoracic injuries. 1,2 It is not uncommon that distracting pain or disability from injuries may lead to undetected shoulder or ACJ injuries. The Advanced Trauma Life Support guideline 7 suggests evaluating breathing using chest radiography but does not recommend the exact radiographic technique (either supine or upright).…”

“…6,18 An ACJ injury can be a concomitant or associated injury in patients with polytrauma or thoracoabdominal injuries. 1,2 Supine or upright chest radiography is the standard investigation tool that is used as an adjunct in the primary survey of patients with polytrauma. Chest radiography can detect bony injuries such as in the scapula, clavicle, and ribs or evaluate cardiopulmonary abnormalities.…”