The relationship between the presence of scapula fracture and mortality and morbidity in cases with blunt thoracic trauma

Abstract

BACKGROUND: Scapula fractures (SFs) occur as a result of high-energy trauma and are significant in terms of life-threatening injuries. There are few studies showing the relationship between SFs and mortality and morbidity in patients with blunt thoracic trauma (BTT). Our study aims to investigate the relationship between SF and mortality and morbidity in BTT. METHODS:Adult patients admitted to the emergency department of Kahramanmaras Sutcu Imam University, School of Medicine with BTT between January 2019 and April 2021 were retrospectively scanned from hospital records. Patients' age, gender, trauma mechanism, additional organ injuries, need for intensive care, length of hospital stay, morbidity, and mortality rates were recorded. Statistical results were expressed as frequency, percentage, and mean±standard deviation (min-max). In comparisons between groups, p<0.05 was accepted as the significance level. RESULTS:Two hundred and thirty-eight cases were included in our study. The scapular fracture was present in 86 cases (36.1%). About 43% of the cases with SFs were falling from a height. Intrathoracic injuries accompanying SF were determined as rib fracture, lung contusion, pneumothorax, hemothorax, and sternum fracture, respectively (91.9%, 80.2%, 41.9%, 37.2%, and 15.1%). Extrathoracic injuries associated with SF were vertebral fractures, intracranial injuries, clavicle fractures, extremity fractures, and intra-abdominal injuries (18.6%, 16.3%, 12.8%, 10.5%, and 5.8%), respectively. When the groups with and without SF were compared, a statistically significant relationship was found between SF and the number of rib fractures, lung contusion, pneumothorax, and hemothorax (p<0.001, p=0.001, p=0.001, p=0.001). In extrathoracic injuries, there was a significant relationship between SFs and vertebral fractures, intracranial injuries, and clavicle fractures (p=0.004, p<0.001, p=0.005). There was no difference observed between the groups regarding sternum fractures, extremity fractures, and intra-abdominal organ injuries (p=0.288, p=0.682, p=0.261). In cases with accompanying SF, there was a significant difference in terms of length of hospital stay, need for intensive care, and mortality (p<0.001, p=0.001, p=0.002). CONCLUSION:The most common intrathoracic injuries accompanying SFs were rib fractures and lung contusion, and the most common extrathoracic injuries were vertebral fractures and intracranial injuries. Moreover, it was found that SF was highly correlated with length of hospital stay, need for intensive care, and mortality. The most common cause of mortality was found to be intracranial hemorrhage. Imaging of other systems is important in cases with SFs. Particular attention should be paid to head-and-neck injuries.

Significance of Scapular Fracture Existence in Blunt Chest Trauma: A Retrospective Cohort Study

“…In agreement with other studies, scapular fracture was significantly associated with thoracic injuries such as multiple rib fractures and pneumothorax [ 1 , 2 , 4 ] ( Table 3 ). A retrospective study over 6 years conducted in the United Kingdom showed that there was no significant difference regarding lung contusion between patients with scapular fractures and patients without fractures [ 18 ].…”

“…Injury severity parameters such as ISS, NIS, and ICU admission were significantly higher in patients with scapular fracture compared to other patients without fracture, which is similar to other studies [ 1 , 4 , 18 ]. Accordingly, as expected, the length of hospital stay was significantly longer in patients with scapular fracture patients who had more severe injuries.…”

“…Abd El-Shafy et al showed that the scapular fracture was associated with great vessel injury, mainly the carotid artery in the neck region [ 21 ]. Another study showed that vertebral fracture, especially in the neck region, was significantly related to the scapular fracture in BCT [ 4 ]. The current study showed that the neck region was the most common extrathoracic injured body region and scapular fracture was significantly associated with neck injury compared to other patients without fracture.…”

“…The scapula is surrounded by strong groups of muscles offering good protection for the bone that needs high-energy trauma to be fractured [ 3 ]. Scapular fractures are usually associated with thoracic injuries such as rib fractures and lung contusions; however, isolated scapular fractures and associated extrathoracic injuries are less common [ 4 , 5 ].…”

“…As a part of the shoulder skeleton, many studies in literature have been conducted on the management of scapular fractures from the orthopedic point of view. However, there is a lack of research regarding the importance of the presence of scapular fractures in BCT patients [ 3 , 4 ].…”