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

M Sinan Bakir; Jan Unterkofler; Alexander Hönning; Lyubomir Haralambiev; Simon Kim; Axel Ekkernkamp; Stefan Schulz-Drost

doi:10.1371/journal.pone.0224370

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

PLoS One. 2019 Oct 25;14(10):e0224370. doi: 10.1371/journal.pone.0224370. eCollection 2019.

Authors

M Sinan Bakir^{1

2}, Jan Unterkofler^{2

3}, Alexander Hönning⁴, Lyubomir Haralambiev^{1

2}, Simon Kim¹, Axel Ekkernkamp^{1

2}, Stefan Schulz-Drost^{2

5

6}

Affiliations

¹ Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, Medical University Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany.
² Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany.
³ Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Nordrhein-Westfalen, Germany.
⁴ Center of Clinical Science, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany.
⁵ Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Erlangen, Bayern, Germany.
⁶ Department of Trauma, Orthopedic and Hand Surgery, Helios Hospital Schwerin, Schwerin, Mecklenburg-Vorpommern, Germany.

Abstract

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Clavicle / injuries*
Female
Germany
Humans
Male
Middle Aged
Retrospective Studies
Shoulder Injuries / therapy*

Associated data

Dryad/10.5061/dryad.q5fk2d7

Grants and funding

The authors acknowledge support for the Article Processing Charge from the DFG (German Research Foundation, 393148499) and the Open Access Publication Fund of the University of Greifswald. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.