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



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.


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.


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.


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


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