The relation between scapula fracture and the severity of trauma in blunt thoracic trauma

The relation between scapula fracture and the severity of trauma in blunt thoracic trauma

Background/aim: The aim of this study was to determine the level of presence of scapula fractures (SFs) in cases of blunt thoracictrauma and to identify other injuries accompanying SF.Materials and methods: Blunt thoracic trauma cases with SF determined on direct radiography or computerized tomography (CT) werecategorized as Group 1. Group 2 was constituted by selecting cases with high injury severity score (ISS) with no SF. The demographiccharacteristics and all injuries of the patients were evaluated.Results: SF was determined in 77 (11.3%) patients (Group 1), and Group 2 consisted of 607 patients. The ISS was significantly higher inGroup 1 (27.7 ± 16.1) than Group 2 (15.9 ± 9.5) (P < 0.001). The rate of SF with direct radiography was only 9.1%, and more than 90%of patients were evaluated using CT. The most common accompanying injury to SF was rib fracture (44.2%), and the odds ratio was 2.4(95% CI: 1.51–3.72).Conclusion: The incidence of SF in cases of blunt trauma was higher than in previous studies. The use of CT in blunt trauma candetermine SF that cannot be identified through physical examination or radiography, and the most commonly observed accompanyingdamage in these patients is rib fracture.

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  • LoCicero J 3rd, Mattox KL. Epidemiology of chest trauma. Surg Clin North Am 1989; 69: 15-19.
  • Brown CV, Velmahos G, Wang D, Kennedy S, Demetriades D, Rhee P. Association of scapular fractures and blunt thoracic aortic injury: fact or fiction? Am Surg 2005; 71: 54-57.
  • Stephens NG, Morgan AS, Corvo P, Bernstein BA. Significance of scapular fracture in the blunt-trauma patient. Ann Emerg Med 1995; 26: 439-442.
  • Scavenius M, Sloth C. Fractures of the scapula. Acta Orthop Belg 1996; 62: 129-132.
  • Tinkoff GH, Reed JF 3rd, Megargel R, Alexander EL, 3rd, Murphy S, Jones MS. Delaware’s inclusive trauma system: impact on mortality. J Trauma 2010; 69: 245-252.
  • Harris RD, Harris JH. The prevalence and significance of missed scapular fractures in blunt chest trauma. Am J Roentgenol 1988; 151: 747-750.
  • Ozmen CA, Onat S, Aycicek D. Radiologic findings of thoracic trauma. Ther Clin Risk Manag 2017; 13: 1085-1089.
  • Langdorf MI, Medak AJ, Hendey GW, Nishijima DK, Mower WR, Raja AS, Baumann BM, Anglin DR, Anderson CL, Lotfipour S et al. Prevalence and clinical import of thoracic injury identified by chest computed tomography but not chest radiography in blunt trauma: multicenter prospective cohort study. Ann Emerg Med 2015; 66: 589-600.
  • Wiklund E, Koskinen SK, Linder F, Aslund PE, Eklof H. Whole body computed tomography for trauma patients in the Nordic countries 2014: survey shows significant differences and a need for common guidelines. Acta Radiol 2016; 57: 750-757.
  • Corbacioglu SK, Er E, Aslan S, Seviner M, Aksel G, Dogan NO, Guler S, Bitir A. The significance of routine thoracic computed tomography in patients with blunt chest trauma. Injury 2015; 46: 849-853.
  • Tadros AM, Lunsjo K, Czechowski J, Abu-Zidan FM. Multipleregion scapular fractures had more severe chest injury than single-region fractures: a prospective study of 107 blunt trauma patients. J Trauma 2007; 63: 889-893.
  • Tadros AM, Lunsjo K, Czechowski J, Abu-Zidan FM. Causes of delayed diagnosis of scapular fractures. Injury 2008; 39: 314- 318.
  • Salimi J, Khaji A, Karbakhsh M, Saadat S, Eftekhar B. Scapular fracture: lower severity and mortality. Sao Paulo Med J 2008; 126: 186-189.
  • Akaraborworn O, Sangthong B, Thongkhao K, Chiniramol P, Kaewsaengrueang K. Scapular fractures and concomitant injuries. Chin J Traumatol 2012; 15: 297-299.
  • Veysi VT, Mittal R, Agarwal S, Dosani A, Giannoudis PV. Multiple trauma and scapular fractures: so what? J Trauma 2003; 55: 1145-1147.
  • Weening B, Walton C, Cole PA, Alanezi K, Hanson BP, Bhandari M. Lower mortality in patients with scapular fractures. J Trauma 2005; 59: 1477-1481.
  • Stephens NG, Morgan AS, Corvo P, Bernstein BA. Significance of scapular fracture in the blunt-trauma patient. Ann Emerg Med 1995; 26: 439-442.
  • Armstrong CP, Vanderspuy J. The fractured scapula - importance and management based on a series of 62 patients. Injury 1984; 15: 324-329.
  • Imatani RJ. Fractures of the scapula: a review of 53 fractures. J Trauma 1975; 15: 473-478.
  • Lantry JM, Roberts CS, Giannoudis PV. Operative treatment of scapular fractures: a systematic review. Injury 2008; 39: 271-283.
  • Thompson DA, Flynn TC, Miller PW, Fischer RP. The significance of scapular fractures. J Trauma 1985; 25: 974-977.
  • McGinnis M, Denton JR. Fractures of the scapula - a retrospective study of 40 fractured scapulae. J Trauma 1989; 29: 1488-1493.
  • McGahan JP, Rab GT, Dublin A. Fractures of the scapula. J Trauma 1980; 20: 880-883.
  • Hasbahçeci M, Özpek A, Başak F, Çalışkan M, Ener BK, Alimoğlu O. Factors affecting mortality in blunt thoracic trauma. Ulus Travma Acil Cer 2013; 19: 127-132 (in Turkish with abstract in English).
  • Kara H, Bayir A, Ak A, Akinci M, Tufekci N, Degirmenci S, Azap M. Trauma in elderly patients evaluated in a hospital emergency department in Konya, Turkey: a retrospective study. Clinical Interv Aging 2014; 9: 17-21.
  • Tucek M, Bartonicek J. Associated injuries of the scapula fractures. Rozhl Chir 2010; 89: 288-292.
  • Ada JR, Miller ME. Scapular fractures. Analysis of 113 cases. Clin Orthop Relat Res 1991; 269: 174-180.
  • Bauer G, Fleischmann W, Dussler E. Displaced scapular fractures - indication and long-term results of open reduction and internalfixation. Arch Orthop Trauma Surg 1995; 114: 215-219.
  • Matthews RE, Cocke TB, D’Ambrosia RD. Scapular fractures secondary to seizures in patients without osteodystrophy. Report of two cases and review of the literature. J Bone Joint Surg Am 1983; 65: 850-853.
  • Wilber MC, Evans EB. Fractures of the scapula. An analysis of forty cases and a review of the literature. J Bone Joint Surg Am 1977; 59: 358-362.
  • Ideberg R, Grevsten S, Larsson S. Epidemiology of scapular fractures. Incidence and classification of 338 fractures. Acta Orthop Scand 1995; 66: 395-397.
  • Nordqvist A, Petersson C. Fracture of the body, neck, or spine of the scapula - a long-term follow-up-study. Clin Orthop Relat Res 1992; 283: 139-144.
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: Yılda 6 Sayı
  • Yayıncı: TÜBİTAK