Influence of an additional clavicle fracture on the fracture distribution of serial rib fractures

Abstract text (incl. references and figure legends)

Objectives: If a clavicle fracture occurs additionaly to a monolateral serial rib fracture, the risk of destabilization of the upper thoracic quadrant is described. Therefore a gatekeeper funktion of the thorax is ascribed to the clavicle fracture. Is there an influence from an additional clavicle fracture on serial rib fracture distribution causing such an instability?

Methodes: During a retrospective analysis of 606 patients with chest trauma, the dirstribution of serial rib fractrues in CT scans was evaluated. Especiallly the effect of an additional clavicle fracture on the discribed distribution was examined.

Results: 542 patients (89,4%) having at least one rib fracture, 76 patients (12,5%) with a clavicle fracture and 69 persons (11,4%) who suffered from both types of fracture. 65,8% of clavicle fractures appeared on the left, in 2,6% the clavicle fracture was located bilateral. Mostly (72,4%) the middle third of the clavicle was affected. In case of a combined costoclavicular injury, striking feature was the shift of the fracture position to a more laterally focused sector of the thoracic wall. In patients with clavicle fracture, the position mean averaged rib fractures was 90.7° (minimum: 20.8° - rib II right; maximum: 149.5° - rib IX left), in patients without clavicle fracture, the position average was 84.9° (minimum: 10.0° - rib IX left; maximum: 160.0° - rib VII left). On the other hand, with additional clavicle fracture, there was a significant cranial shift of the fracture zone (focus rib II-VI) compared to the control group without clavicle fracture (focus ribs IV-VIII).

Approximately one out of nine patients had a costoclavicular combination injury. In additive clavicle fracture, a shift of the fracture pattern from serial rib fractures to lateral and cranial along the chest wall is noticable. This supports the thesis of an upper quadrant instability of the thoracic wall, which is partly caused by the appearence of additional clavicle fractures.

Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)