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Shoulder girdle injuries involving the medial clavicle differ from lateral clavicle injuries with a focus on concomitant injuries and management strategies: A retrospective study based on nationwide routine data


Autoři: M. Sinan Bakir aff001;  Jan Unterkofler aff002;  Alexander Hönning aff004;  Lyubomir Haralambiev aff001;  Simon Kim aff001;  Axel Ekkernkamp aff001;  Stefan Schulz-Drost aff002
Působiště autorů: Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany aff001;  Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany aff002;  Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Nordrhein-Westfalen, Germany aff003;  Center of Clinical Science, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany aff004;  Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Erlangen, Bayern, Germany aff005;  Department of Trauma, Orthopedic and Hand Surgery, Helios Hospital Schwerin, Schwerin, Mecklenburg-Vorpommern, Germany aff006
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0224370

Souhrn

Introduction

Although shoulder girdle injuries are frequent, those of the medial part are widely unexplored. Our aim is to improve the knowledge of this rare injury and its management in Germany by big data analysis.

Methods

The data are based on ICD-10 codes of all German hospitals as provided by the German Federal Statistical Office. Based on the ICD-10 codes S42.01 (medial clavicle fracture, MCF) and S43.2 (sternoclavicular joint dislocation, SCJD), anonymized patient data from 2012 to 2014 were evaluated retrospectively for epidemiologic issues. We analyzed especially the concomitant injuries and therapy strategies.

Results

A total of 114,003 cases with a clavicle involving shoulder girdle injury were identified with 12.5% of medial clavicle injuries (MCI). These were accompanied by concomitant injuries, most of which were thoracic and craniocerebral injuries as well as injuries at the shoulder/upper arm. A significant difference between MCF and SCJD concerning concomitant injuries only appears for head injuries (p = 0.003). If MCI is the main diagnosis, soft tissue injuries typically occur as secondary diagnoses. The MCI are significantly more often associated with concomitant injuries (p < 0.001) for almost each anatomic region compared with lateral clavicle injuries (LCI). The main differences were found for thoracic and upper extremity injuries. Different treatment strategies were used, most frequently plate osteosynthesis in more than 50% of MCF cases. Surgery on SCJD was performed with K-wires, tension flange or absorbable materials, fewer by plate osteosynthesis.

Conclusions

We proved that MCI are rare injuries, which might be why they are treated by inhomogeneous treatment strategies. No standard procedure has yet been established. MCI can occur in cases of severely injured patients, often associated with severe thoracic or other concomitant injuries. Therefore, MCI appear to be more complex than LCI. Further studies are required regarding the development of standard treatment strategy and representative clinical studies.

Klíčová slova:

Bone fracture – Head injury – Shoulders – Skeletal joints – Surgical and invasive medical procedures – Trauma surgery – Traumatic injury


Zdroje

1. Postacchini R, Gumina S, Farsetti P, Postacchini F. Long-term results of conservative management of midshaft clavicle fracture. International Orthopaedics. 2010;34(5):731–6. doi: 10.1007/s00264-009-0850-x 19669643

2. Cave AJ. The nature and morphology of the costoclavicular ligament. J Anat. 1961;(95):170–9.

3. Klonz A, Hockertz T, Reilmann H. [Clavicular fractures]. Der Unfallchirurg. 2001;104(1):70–81; quiz 0. 11381765

4. Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elbow Surg. 2002;11(5):452–6. 12378163

5. Wirth MA, Rockwood CA Jr. Acute and Chronic Traumatic Injuries of the Sternoclavicular Joint. J Am Acad Orthop Surg. 1996;4(5):268–78. 10797194

6. Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res. 1994;(300):127–32. 8131324

7. Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br. 1998;80(3):476–84. doi: 10.1302/0301-620x.80b3.8079 9619941

8. Gottschalk HP, Browne RH, Starr AJ. Shoulder girdle: patterns of trauma and associated injuries. J Orthop Trauma. 2011;25(5):266–71. doi: 10.1097/BOT.0b013e3181e47975 21464745

9. Guan JJ, Wolf BR. Reconstruction for anterior sternoclavicular joint dislocation and instability. J Shoulder Elbow Surg. 2013;22(6):775–81. doi: 10.1016/j.jse.2012.07.009 22981353

10. Adamcik S, Ahler M, Gioutsos K, Schmid RA, Kocher GJ. Repair of sternoclavicular joint dislocations with FiberWire®. Archives of Orthopaedic and Trauma Surgery. 2017;137(3):341–5. doi: 10.1007/s00402-017-2632-z 28110364

11. Aydın E, Dülgeroğlu TC, Ateş A, Metineren H. Repair of Unstable Posterior Sternoclavicular Dislocation Using Nonabsorbable Tape Suture and Tension Band Technique: A Case Report with Good Results. Case Reports in Orthopedics. 2015;2015:1–3. doi: 10.1155/2015/750898 26613059

12. Hwang WJ, Lee Y, Yoon YS, Kim YJ, Ryu HY. Surgical Treatment of Sternoclavicular Joint Dislocation Using a T-plate. The Korean Journal of Thoracic and Cardiovascular Surgery. 2016;49(3):221–3. doi: 10.5090/kjtcs.2016.49.3.221 27298805

13. Morell DJ, Thyagarajan DS. Sternoclavicular joint dislocation and its management: A review of the literature. World Journal of Orthopedics. 2016;7(4):244. doi: 10.5312/wjo.v7.i4.244 27114931

14. Unterkofler J, Merschin D, Langenbach A, Ekkernkamp A, Schulz-Drost S. Injuries of the Sternoclavicular Joint—An Innovative Approach in the Management of a Rare Injury: Tight Rope Fixation of the Costo-Clavicular Ligament. Chirurgia (Bucur). 2017;112(5):611–8. doi: 10.21614/chirurgia.112.5.611 29088561

15. Bakir MS, Merschin D, Unterkofler J, Guembel D, Langenbach A, Ekkernkamp A, 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. doi: 10.21614/chirurgia.112.5.586 29088558

16. Herteleer M, Winckelmans T, Hoekstra H, Nijs S. Epidemiology of clavicle fractures in a level 1 trauma center in Belgium. Eur J Trauma Emerg Surg. 2018;44(5):717–26. doi: 10.1007/s00068-017-0858-7 29027569

17. Huttunen TT, Launonen AP, Berg HE, Lepola V, Felländer-Tsai L, Mattila VM. Trends in the Incidence of Clavicle Fractures and Surgical Repair in Sweden: 2001–2012. J Bone Joint Surg Am. 2016;98(21):1837–42. doi: 10.2106/JBJS.15.01284 27807117

18. Kihlström C, Möller M, Lönn K, Wolf O. Clavicle fractures: epidemiology, classification and treatment of 2 422 fractures in the Swedish Fracture Register; an observational study. BMC Musculoskelet Disord. 2017;18(1):82. doi: 10.1186/s12891-017-1444-1 28202071

19. Moseley HF. The clavicle: its anatomy and function. Clin Orthop Relat Res. 1968;58:17–27. 5666861

20. Worman LW, Leagus C. Intrathoracic injury following retrosternal dislocation of the clavicle. J Trauma. 1967;7(3):416–23. doi: 10.1097/00005373-196705000-00006 5337310

21. Nakayama E, Tanaka T, Noguchi T, Yasuda J-i, Terada Y. Tracheal stenosis caused by retrosternal dislocation of the right clavicle. Ann Thorac Surg. 2007;83(2):685–7. doi: 10.1016/j.athoracsur.2006.06.022 17258018

22. Jain S, Monbaliu D, Thompson JF. Thoracic outlet syndrome caused by chronic retrosternal dislocation of the clavicle. Successful treatment by transaxillary resection of the first rib. J Bone Joint Surg Br. 2002;84(1):116–8. doi: 10.1302/0301-620x.84b1.12285 11838442

23. Brämer GR. International Statistical Classification of Diseases and Related Health Problems, 10th Revision. World Health Stat Q. 1998;41(1):32–6.

24. Bundesministerium der Justiz und für Verbraucherschutz. Krankenhausentgeltgesetz 2013; 860–5–24 §. https://www.gesetze-im-internet.de/khentgg/__4.html.

25. Oestern HJ, Tscherne H. [Pathophysiology and classification of soft tissue damage in fractures]. Orthopade. 1983;12(1):2–8. Epub 1983/01/01. 6844016.

26. DIMDI German Institute of Medical Documentation and Information. German procedure classification (Operationen- und Prozedurenschlüssel—OPS). 2017 [cited 10 November 2018]. In: DIMDI Classifications [Internet]. Cologne, Germany. Available from: https://www.dimdi.de/dynamic/en/classifications/ops/index.html.

27. Van Tassel D, Owens BD, Pointer L, Moriatis Wolf J. Incidence of clavicle fractures in sports: analysis of the NEISS Database. Int J Sports Med. 2014;35(1):83–6. doi: 10.1055/s-0033-1345127 23771828

28. Maegele M, Lefering R, Sakowitz O, Kopp MA, Schwab JM, Steudel W-I, et al. The Incidence and Management of Moderate to Severe Head Injury. Dtsch Arztebl Int. 2019;116(10):167–73. doi: 10.3238/arztebl.2019.0167 30995953

29. Horst K, Hildebrand F, Kobbe P, Pfeifer R, Lichte P, Andruszkow H, et al. Detecting severe injuries of the upper body in multiple trauma patients. J Surg Res. 2015;199(2):629–34. doi: 10.1016/j.jss.2015.06.030 26169033

30. Stahl D, Ellington M, Brennan K, Brennan M. Association of Ipsilateral Rib Fractures With Displacement of Midshaft Clavicle Fractures. J Orthop Trauma. 2017;31(4):225–8. doi: 10.1097/BOT.0000000000000758 28328731

31. Langenbach A, Pinther M, Krinner S, Grupp S, Ekkernkamp A, Hennig FF, et al. Surgical Stabilization of Costoclavicular Injuries—A Combination of Flail Chest Injuries and a Clavicula Fracture. Chirurgia (Bucur). 2017;112(5):595–606. doi: 10.21614/chirurgia.112.5.595 29088559

32. Unterkofler J, Schulz-Drost S, Ekkernkamp A. Epidemiologie der Verletzungen des sternoklavikularen Gelenks und der angrenzenden Klavikula in Deutschland. Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2016). 2016. doi: 10.3205/16dkou186

33. Allman FL. Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg Am. 1967;49(4):774–84. 6026010

34. Filler BC. Coding basics for orthopaedic surgeons. Clin Orthop Relat Res. 2007;457:105–13. doi: 10.1097/BLO.0b013e31803372b8 17259901

35. Klaus B, Ritter A, Grosse Hülsewiesche H, Beyrle B, Euler HU, Fender H, et al. [Study of the quality of codification of diagnoses and procedures under DRG conditions]. Gesundheitswesen. 2005;67(1):9–19. doi: 10.1055/s-2004-813833 15672301

36. DGUV German statutory accident insurance. Verletzungsartenverzeichnis mit Erläuterungen unter Einschluss des Schwerstverletzungsartenverfahrens. 2014 [cited 20 July 2019]. In: DGUV Documents. Berlin, Germany. Available from: https://www.dguv.de/medien/landesverbaende/de/med_reha/documents/verletz3.pdf.

37. Tepolt F, Carry PM, Heyn PC, Miller NH. Posterior sternoclavicular joint injuries in the adolescent population: a meta-analysis. Am J Sports Med. 2014;42(10):2517–24. doi: 10.1177/0363546514523386 24569702


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