Risk stratification by injury distribution in polytrauma patients - does the clavicular fracture play a role?

Thoracic and extremity injuries are common in polytraumatized patients. The clavicle limits the upper thoracic cage and connects the body and upper extremities. It is easy to examine and is visible on standard emergency room radiographs. We hypothesize that clavicular fracture in polytrauma patients indicates the presence of further injuries of the upper extremities, head, neck and thorax.

Retrospective study including patients admitted between 2008 and 2012 to a level-I trauma center.

ISS > 16, two or more injured body regions, clavicular fracture.

patients admitted in 2011, ISS > 16, two or more injured body regions, no clavicular fracture. Patient information was obtained from the patients' charts; evaluation of radiographic findings was performed; scoring was based on the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) AIS/ISS; data were analyzed using Pearson's correlation and the Mann-Whitney U-test in SPSS (version 11.5.1); graphs were drawn using EXCEL®.

Thirty-four patients with clavicular fracture (C+) and 40 without (C-) were included; the mean ISS was 25 (range 16-57), m = 70%, f = 30%; age 43.3 years (range 9-88); clavicular fractures were positively correlated with severe thoracic (p = 0.011, OR 4.5: KI 1.3-15.3), external (p < 0.001, OR 9.2: KI 2.7-30.9) and upper extremity injuries (p < 0.001, OR 33.2: KI 6.9-16.04 resp. p = 0.004, OR 12.5: KI 1.5-102.9). C + showed a lower head/neck AIS (p = 0.033), higher thorax AIS (p = 0.04), arm/shoulder AIS (p = 0.001) and external AIS (0.003) than C-. Mean hospital stay and ICU treatment time were longer in the C + group (p = 0.001 and p = 0.025 respectively).

A clavicular fracture can be diagnosed easily and may be used as a pointer for further thoracic and upper extremity injuries in polytrauma patients that might have been otherwise missed. Special attention should be paid on second and tertiary survey.