Subclavian artery injury and fracture of the scapula

Halpern, Alan A.; Joseph, Ronald; Page, James; Nagel, Donald A.

doi:10.1016/s0361-1124(79)80443-8

Cited by 8 publications

(2 citation statements)

References 4 publications

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“…The incidence of vascular injury with peri-clavicular trauma was about 5.5–14% [1]. Some studies have reported that TSVI was one of the more common injuries associated with fractures of the clavicle [6, 14, 18], while a few studies have addressed the association of scapular fracture with TSVI [15, 19]. In this study, clavicular fracture occurred in 27.3% of our patients and there were two cases with scapular fractures.…”

Section: Discussionmentioning

confidence: 99%

Eighteen years’ experience of traumatic subclavian vascular injury in a tertiary referral trauma center

Kou

Liao

Huang

et al. 2019

Eur J Trauma Emerg Surg

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PurposeTraumatic subclavian vascular injury (TSVI) is rare but often fatal. The precise diagnosis of TSVI remains challenging mainly because of its occult nature, less typical presentations, and being overlooked in the presence of polytrauma. Compared to penetrating injuries, it is even more difficult to identify TSVI in patients who have blunt injuries and no visible bleeding. The risk factors associated with TSVI in patients with thoracic trauma are unclear. The aims of this study were to identify risk factors for TSVI in a cohort of patients with thoracic vascular injuries and to report outcomes after clinical treatment.MethodsFrom January 2009 to June 2017, 39586 patients were admitted to our hospital (a level I trauma center) due to trauma, and 136 patients with thoracic vascular injury were enrolled in this study. We retrospectively reviewed data from medical records including demographic characteristics, injury scoring systems (RTS, ISS, NISS, TRISS and AIS), management and outcomes. Patients were further divided into the TSVI group (patients with TSVI) and the non-TSVI group (patients with thoracic vascular injuries other than TSVI). Univariate and multivariate analyses were used to identify independent risk factors.ResultsThe enrolled 136 patients suffered mostly from blunt trauma (89.0%) and 22 of them had TSVI. When compared to the non-TSVI group, the TSVI group had lower Glasgow Coma Scale (GCS) scores (p = 0.002; especially GCS ≤ 12), less concurrent abdominal injury (p < 0.001), lower Injury Severity Scales (ISS) (p = 0.007) and New Injury Severity Scales (NISS) (p < 0.002) but had higher Abbreviated Injury Scales (AIS) of the head ≥ 3 (p = 0.009) and rates of clavicular or scapular fractures (p = 0.013). No difference was detected between the two groups with regard to age, gender, trauma mechanism, vital signs on arrival, or rate of facial and extremities injury. In multivariate regression analyses, GCS ≤ 12, AIS of the head ≥ 3 and the presence of clavicular or scapular fractures were independent risk factors for TSVI (p = 0.026, p = 0.043 and p = 0.005, respectively) after adjustment for confounding factors. Open and endovascular repair were two surgical procedures utilized for these TSVI patients with an overall mortality rate of 18.2%. No difference was found between these groups with regard to mortality rate and the length of ICU stay, but the patients in the TSVI group had a shorter length of hospital stay.ConclusionsOur results suggest that GCS ≤ 12, AIS of the head ≥ 3 and the presence of clavicular or scapular fractures were independent risk factors for TSVI in patients with thoracic vascular injuries. For patients with thoracic trauma, TSVI should be considered for prompt management when patients exhibit concurrent injuries to the head, clavicle or scapula.

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Section: Discussionmentioning

confidence: 99%

Eighteen years’ experience of traumatic subclavian vascular injury in a tertiary referral trauma center

Kou

Liao

Huang

et al. 2019

Eur J Trauma Emerg Surg

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“…The latter are present in about 10-12%. Lesions to the brachial plexus, the axillary artery or the subclavian vein occur (6,10,26,34).…”

Section: Epidemiology Etiology and Classificationmentioning

confidence: 99%

Fractures of the Scapula

Südkamp¹,

Jaeger²,

Bornebusch³

et al. 2011

ACHOT

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The scapula connects the arm with the chest wall and is therefore of great importance for a free range of shoulder of motion. For a long-term scapular fractures had been treated predominantly conservative. However, clinical studies of the past decades revealed that some fracture patterns deserve operative treatment to prevent unfavorable functional outcome and chronic state of pain.Scapular fractures are predominantly acquired during highy-energy trauma and these patients' presents with a mean of 3.9 associated injuries in the emergency department. Injuries to the head, chest and ipsilateral upper extremity are most common. As some of these injuries are possibly life threatening they are treated first. Scapular fractures are only very seldom surgical emergencies. Therefore they are treated during the phase of reconvalescence in polytraumatized patients.Decision-making should be based on a thoroughgoing diagnostics, including conventional x-rays and a CT-scan, epically in cases of glenoid neck or cavity fractures. All fracture patterns should be identified to there full extend and put into the context of the scapular suspensory complex.The OTA lately presented a new and comprehensive system for classification of the scapular fractures. It is divided in two levels. Level one for the general orthopedic or trauma surgeon and Level two for the advanced upper Extremity or Shoulder surgeon. This classification scheme allows an easy access to understanding of the severity and prognostics of scapular fractures. As a general guideline surgery is indicated if a double disruption of the Scapula suspensory system, a relevant malposition or dysintegrity of the glenoid (articular surface) or a displacement of the lateral column is present.

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Fractures of the Scapula

Suedkamp

Izadpanah

2014

European Surgical Orthopaedics and Traumatology

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Subclavian artery injury and fracture of the scapula

Cited by 8 publications

References 4 publications

Eighteen years’ experience of traumatic subclavian vascular injury in a tertiary referral trauma center

Eighteen years’ experience of traumatic subclavian vascular injury in a tertiary referral trauma center

Fractures of the Scapula

Fractures of the Scapula

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