gms | German Medical Science

Fragestellung: Clavicle fractures are common fractures accounting for 2–6% of all fractures of the adult population and 10–15% of all paediatric fractures. Clavicle fractures commonly result not only from direct trauma but also from specific bending stresses affecting the shoulder and sternoclavicular joint. The aim of this study was to examine the impact of specific patient-related and trauma-related parameters on the occurrence and type of clavicle fractures.

Methodik: All patients referred to a European Level I trauma centre over a six-year period were retrospectively included, provided the diagnosis of a clavicle fracture was documented either on plain radiographs or on CT scans. Information regarding demographics, time of injury, mechanism of injury, injured side, fracture classification, shortening and displacement of the fracture fragments as well as presence and type associated lesions were extracted from the local trauma database and evaluated. Based on the mechanism of injury, patients were assigned to six subgroups related to the amount of energy transferred to the body at the moment of the accident and classified in a dichotomic way into high- and low-energy mechanisms according to national guidelines.

Ergebnisse und Schlussfolgerung: In total 281 patients reporting clavicle fractures were included, with a male predominance. A motor vehicle accident (MVA) with speed difference > 30 km/h was the most frequently observed mechanism of injury. In total 40% of accidents were high-energy accidents, with male patients being 3 times more frequently affected by high-energy accidents than female patients. The women’s odds of sustaining clavicle fractures after high-energy trauma were 0.61; specifically, their probability of sustaining fractures after falls from heights > 3 m or in in high-speed MVA (speed difference > 30 km/h) was respectively 33% and 40% lower than that of sustaining fractures after falls from lower hights or in MVA with lesser speed difference. A multivariate logistic regression analysis showed that the odds of sustaining clavicle fractures after high-energy trauma increases by 1.3 in patients aged 35–55 and drops to 0.47 in patients aged > 55, as compared to patients younger than 35 years (p = 0.024). Associated injuries were present in 71% of the cases and trauma mechanism correlated to the presence of associated injuries (p < 0.001). Age and trauma mechanism did not show any significant relation with the fracture classification, with clavicle shortening and with fracture displacement. Only the presence of multifragmented fractures was found to be associated to a higher degree of shortening and fragment displacement (p < 0.001, p < 0.001).

This epidemiological study presents a detailed description of the demographic and trauma-related characteristics of patients reporting clavicle fractures referred to a European Level I trauma centre. Age and machanism of injury play a relevant role in epidemiology and are associated with fracture morphology and concomitant injuries.