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Management of Associated Injuries (Clavicle and Scapula)

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Injuries to the Chest Wall

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Abstract

The shoulder girdle is a common vernacular for referencing a complex musculoskeletal arrangement which allows for coordinated function of the humerus, clavicle, scapula, and thorax. Shoulder girdle injuries cross a large spectrum ranging from sterno- and acromioclavicular disruptions, to complex fractures, to muscular tears. In the context of chest wall injuries, particularly multi-segment rib fractures occurring in high-energy mechanisms, ipsilateral injuries to the shoulder girdle are common. This chapter will describe the diagnosis, treatment, and outcome of associated injuries to the clavicle and scapula.

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References

  1. Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma. 1993;7(2):99–106.

    Article  CAS  PubMed  Google Scholar 

  2. Thompson DA, Flynn TC, Miller PW, Fischer RP. The significance of scapular fractures. J Trauma. 1985;25(10):974–7.

    Article  CAS  PubMed  Google Scholar 

  3. McGahan JP, Rab GT, Dublin A. Fractures of the scapula. J Trauma. 1980;20(10):880–3.

    Article  CAS  PubMed  Google Scholar 

  4. Veysi VT, Mittal R, Agarwal S, Dosani A, Giannoudis PV. Multiple trauma and scapula fractures: so what? J Trauma. 2003;55(6):1145–7.

    Article  PubMed  Google Scholar 

  5. Stephens NG, Morgan AS, Corvo P, Bernstein BA. Significance of scapular fracture in the blunt-trauma patient. Ann Emerg Med. 1995;26(4):439–42.

    Article  CAS  PubMed  Google Scholar 

  6. Baldwin KD, Ohman-Strickland P, Mehta S, Hume E. Scapula fractures: a marker for concomitant injury? A retrospective review of data in the national trauma database. J Trauma. 2008;65(2):430–5.

    Article  PubMed  Google Scholar 

  7. Hippocrates. On the articulations. The genuine works of Hippocrates. Clin Orthop Relat Res. 2002;400(July):19–25. doi:10.1097/00007611-192206000-00025.

  8. Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br Vol. 1998;80(3):476–84.

    Article  CAS  Google Scholar 

  9. Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elb Surg. 2002;11(5):452–6.

    Article  Google Scholar 

  10. Liu GD, Tong SL, Ou S, et al. Operative versus non-operative treatment for clavicle fracture: a meta-analysis. Int Orthop. 2013;37(8):1495–500.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Gardner E. The embryology of the clavicle. Clin Orthop Relat Res. 1968;58:9–16.

    Article  CAS  PubMed  Google Scholar 

  12. McGraw MA, Mehlman CT, Lindsell CJ, Kirby CL. Postnatal growth of the clavicle: birth to 18 years of age. J Pediatr Orthop. 2009;29(8):937–43.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Inman VT, Saunders JB. Observations on the function of the clavicle. Calif Med. 1946;65(4):158–66.

    PubMed Central  CAS  PubMed  Google Scholar 

  14. Andermahr J, Ring D, Jupiter JB. Fractures and dislocations of the clavicle. In: Browner BD, Jupiter JB, Krettek C, Anderson P, editors. Skeletal trauma: basic science, management, and reconstruction. 5th ed. Philadelphia: Elsevier/Saunders. 2015;1499–1518.

    Google Scholar 

  15. Renfree KJ, Riley MK, Wheeler D, Hentz JG, Wright TW. Ligamentous anatomy of the distal clavicle. J Shoulder Elb. 2003;12(4):355–9.

    Article  Google Scholar 

  16. Rios CG, Arciero RA, Mazzocca AD. Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2007;35(5):811–7.

    Article  PubMed  Google Scholar 

  17. Moseley HF. The clavicle: its anatomy and function. Clin Orthop Relat Res. 1968;58:17–27.

    Article  CAS  PubMed  Google Scholar 

  18. Fischer E. Tubercles for muscular and ligament fixation of the clavicle; a contribution to normal roentgenological anatomy. Fortschr Geb Rontgenstr Nuklearmed. 1958;88(1):71–5.

    Article  CAS  PubMed  Google Scholar 

  19. Hoppenfeld S, deBoer P, Buckley R. Surgical exposures in orthopaedics: the anatomic approach. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2009. p. 2–3.

    Google Scholar 

  20. Sinha A, Edwin J, Sreeharsha B, Bhalaik V, Brownson P. A radiological study to define safe zones for drilling during plating of clavicle fractures. J Bone Joint Surg (Br). 2011;93(9):1247–52. doi:10.1302/0301-620X.93B9.25739.

    Article  CAS  Google Scholar 

  21. Banerjee R, Waterman B, Padalecki J, Robertson W. Management of distal clavicle fractures. J Am Acad Orthop Surg. 2011;19(7):392–401.

    PubMed  Google Scholar 

  22. Williams GR, Nguyen VD, Rockwood CA. Classification and radiographic analysis of acromioclavicular dislocations. Appl Radiol. 1989;18:29–34.

    Google Scholar 

  23. Andersen K, Jensen PO, Lauritzen J. Treatment of clavicular fractures. Figure-of-eight bandage versus a simple sling. Acta Orthop Scand. 1987;58(1):71–4.

    Article  CAS  PubMed  Google Scholar 

  24. Plocher EK, Anavian J, Vang S, Cole PA. Progressive displacement of clavicular fractures in the early postinjury period. J Trauma. 2011;70(5):1263–7.

    Article  PubMed  Google Scholar 

  25. Altamimi SA, McKee MD. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. Surgical technique. J Bone Joint Surg Am Vol. 2008;90(Suppl 2 Pt 1):1–8.

    Google Scholar 

  26. Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007;89(1):1–10. doi:10.2106/JBJS.F.00020.

  27. Murray IR, Foster CJ, Eros A, Robinson CM. Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle. J Bone Joint Surg Am Vol. 2013;95(13):1153–8.

    Article  CAS  Google Scholar 

  28. McKee RC, Whelan DB, Schemitsch EH, McKee MD. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am. 2012;94(8):675–84.

    Google Scholar 

  29. Robinson CM, Goudie EB, Murray IR, et al. Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled trial. J Bone Joint Surg Am Vol. 2013;95(17):1576–84.

    Article  CAS  Google Scholar 

  30. Pearson AM, Tosteson AN, Koval KJ, et al. Is surgery for displaced, midshaft clavicle fractures in adults cost-effective? Results based on a multicenter randomized, controlled trial. J Orthop Trauma. 2010;24(7):426–33.

    Article  PubMed  Google Scholar 

  31. Taylor PR, Day RE, Nicholls RL, Rasmussen J, Yates PJ, Stoffel KK. The comminuted midshaft clavicle fracture: a biomechanical evaluation of plating methods. Clin Biomech (Bristol, Avon). 2011;26(5):491–6.

    Article  Google Scholar 

  32. Coupe BD, Wimhurst JA, Indar R, Calder DA, Patel AD. A new approach for plate fixation of midshaft clavicular fractures. Injury. 2005;36(10):1166–71.

    Article  CAS  PubMed  Google Scholar 

  33. Collinge C, Devinney S, Herscovici D, DiPasquale T, Sanders R. Anterior-inferior plate fixation of middle-third fractures and nonunions of the clavicle. J Orthop Trauma. 2006;20(10):680–6.

    Article  PubMed  Google Scholar 

  34. Smekal V, Irenberger A, Struve P, Wambacher M, Krappinger D, Kralinger FS. Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized, controlled, clinical trial. J Orthop Trauma. 2009;23(2):106–12.

    Article  PubMed  Google Scholar 

  35. Marlow WJ, Ralte P, Morapudi SP, Bassi R, Fischer J, Waseem M. Intramedullary fixation of diaphyseal clavicle fractures using the rockwood clavicle pin: review of 86 cases. Open Orthop J. 2012;6:482–7.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Mudd CD, Quigley KJ, Gross LB. Excessive complications of open intramedullary nailing of midshaft clavicle fractures with the Rockwood Clavicle Pin. Clin Orthop Relat Res. 2011;469(12):3364–70.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Strauss EJ, Egol KA, France MA, Koval KJ, Zuckerman JD. Complications of intramedullary Hagie pin fixation for acute midshaft clavicle fractures. J Shoulder Elb Surg. 2007;16(3):280–4.

    Article  Google Scholar 

  38. Boehme D, Curtis Jr RJ, DeHaan JT, Kay SP, Young DC, Rockwood Jr CA. The treatment of nonunion fractures of the midshaft of the clavicle with an intramedullary Hagie pin and autogenous bone graft. Instr Course Lect. 1993;42:283–90.

    CAS  PubMed  Google Scholar 

  39. Connolly JF. Non-union of fractures of the mid-shaft of the clavicle. Treatment with a modified Hagie intramedullary pin and autogenous bone-grafting. J Bone Joint Surg Am Vol. 1992;74(9):1430–1.

    CAS  Google Scholar 

  40. Boehme D, Curtis Jr RJ, DeHaan JT, Kay SP, Young DC, Rockwood Jr CA. Non-union of fractures of the mid-shaft of the clavicle. Treatment with a modified Hagie intramedullary pin and autogenous bone-grafting. J Bone Joint Surg Am Vol. 1991;73(8):1219–26.

    CAS  Google Scholar 

  41. Jubel A, Andermahr J, Schiffer G, Rehm KE. Technique of intramedullary osteosynthesis of the clavicle with elastic titanium nails. Unfallchirurg. 2002;105(6):511–6.

    Article  CAS  PubMed  Google Scholar 

  42. Jones LD, Grammatopoulos G, Kambouroglou G. Titanium elastic nails, open reduction internal fixation and non-operative management for middle third clavicle fractures: a comparative study. Eur J Orthop Surg Traumatol. 2014;24(3):323–9.

    Article  PubMed  Google Scholar 

  43. Tarng YW, Yang SW, Fang YP, Hsu CJ. Surgical management of uncomplicated midshaft clavicle fractures: a comparison between titanium elastic nails and small reconstruction plates. J Shoulder Elb Surg. 2012;21(6):732–40.

    Article  Google Scholar 

  44. Rieser GR, Edwards K, Gould GC, Markert RJ, Goswami T, Rubino LJ. Distal-third clavicle fracture fixation: a biomechanical evaluation of fixation. J Shoulder Elb Surg. 2013;22(6):848–55.

    Article  Google Scholar 

  45. Yang SW, Lin LC, Chang SJ, Kuo SM, Hwang LC. Treatment of acute unstable distal clavicle fractures with single coracoclavicular suture fixation. Orthopedics. 2011;34(6):172.

    PubMed  Google Scholar 

  46. Chen CY, Yang SW, Lin KY, et al. Comparison of single coracoclavicular suture fixation and hook plate for the treatment of acute unstable distal clavicle fractures. J Orthop Surg Res. 2014;9:42.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Schmittinger K, Sikorski A. Experiences with the Balser plate in dislocations of the acromioclavicular joint and lateral fractures of the clavicle. Aktuelle Traumatol. 1983;13(5):190–3.

    CAS  PubMed  Google Scholar 

  48. Nadarajah R, Mahaluxmivala J, Amin A, Goodier DW. Clavicular hook-plate: complications of retaining the implant. Injury. 2005;36(5):681–3.

    Article  CAS  PubMed  Google Scholar 

  49. Glass ER, Thompson JD, Cole PA, Gause 2nd TM, Altman GT. Treatment of sternoclavicular joint dislocations: a systematic review of 251 dislocations in 24 case series. J Trauma. 2011;70(5):1294–8.

    Article  PubMed  Google Scholar 

  50. Thut D, Hergan D, Dukas A, Day M, Sherman OH. Sternoclavicular joint reconstruction–a systematic review. Bull NYU Hosp Joint Dis. 2011;69(2):128–35.

    Google Scholar 

  51. Groh GI, Wirth MA. Management of traumatic sternoclavicular joint injuries. J Am Acad Orthop Surg. 2011;19(1):1–7.

    PubMed  Google Scholar 

  52. Groh GI, Wirth MA, Rockwood Jr CA. Treatment of traumatic posterior sternoclavicular dislocations. J Shoulder Elb Surg. 2011;20(1):107–13.

    Article  Google Scholar 

  53. Rockwood Jr CA, Groh GI, Wirth MA, Grassi FA. Resection arthroplasty of the sternoclavicular joint. J Bone Joint Surg Am Vol. 1997;79(3):387–93.

    Google Scholar 

  54. Bartonicek J, Cronier P. History of the treatment of scapula fractures. Arch Orthop Trauma Surg. 2010;130(1):83–92.

    Article  PubMed  Google Scholar 

  55. Ideberg R, Grevsten S, Larsson S. Epidemiology of scapular fractures. Incidence and classification of 338 fractures. Acta Orthop Scand. 1995;66(5):395–7.

    Article  CAS  PubMed  Google Scholar 

  56. Sudkamp NP, Jaeger N, Bornebusch L, Maier D, Izadpanah K. Fractures of the scapula. Acta Chir Orthop Traumatol Cech. 2011;78(4):297–304.

    CAS  PubMed  Google Scholar 

  57. Sammarco VJ. Os acromiale: frequency, anatomy, and clinical implications. J Bone Joint Surg Am Vol. 2000;82(3):394–400.

    CAS  Google Scholar 

  58. Ogawa K, Yoshida A, Takahashi M, Ui M. Fractures of the coracoid process. J Bone Joint Surg Br Vol. 1997;79(1):17–9.

    Article  CAS  Google Scholar 

  59. Eyres KS, Brooks A, Stanley D. Fractures of the coracoid process. J Bone Joint Surg Br Vol. 1995;77(3):425–8.

    CAS  Google Scholar 

  60. Ogawa K, Naniwa T. Fractures of the acromion and the lateral scapular spine. J Shoulder Elb Surg. 1997;6(6):544–8.

    Article  CAS  Google Scholar 

  61. Kuhn JE, Blasier RB, Carpenter JE. Fractures of the acromion process: a proposed classification system. J Orthop Trauma. 1994;8(1):6–13.

    Article  CAS  PubMed  Google Scholar 

  62. Mayo KA, Benirschke SK, Mast JW. Displaced fractures of the glenoid fossa. Results of open reduction and internal fixation. Clin Orthop Relat Res. 1998;347:122–30.

    Article  PubMed  Google Scholar 

  63. Jaeger M, Lambert S, Sudkamp NP, et al. The AO foundation and orthopaedic trauma association (AO/OTA) scapula fracture classification system: focus on glenoid fossa involvement. J Shoulder Elb Surg. 2013;22(4):512–20.

    Article  Google Scholar 

  64. Cole PA, Gauger EM, Schroder LK. Management of scapular fractures. J Am Acad Orthop Surg. 2012;20(3):130–41.

    Article  PubMed  Google Scholar 

  65. Anavian J, Conflitti JM, Khanna G, Guthrie ST, Cole PA. A reliable radiographic measurement technique for extra-articular scapular fractures. Clin Orthop Relat Res. 2011;469(12):3371–8.

    Article  PubMed Central  PubMed  Google Scholar 

  66. Armstrong CP, Van der Spuy J. The fractured scapula: importance and management based on a series of 62 patients. Injury. 1984;15(5):324–9.

    Article  CAS  PubMed  Google Scholar 

  67. Ada JR, Miller ME. Scapular fractures. Analysis of 113 cases. Clin Orthop Relat Res. 1991;269:174–80.

    PubMed  Google Scholar 

  68. 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;283:139–44.

    PubMed  Google Scholar 

  69. Bauer G, Fleischmann W, Dussler E. Displaced scapular fractures: indication and long-term results of open reduction and internal fixation. Arch Orthop Trauma Surg. 1995;114(4):215–9.

    Article  CAS  PubMed  Google Scholar 

  70. Romero J, Schai P, Imhoff AB. Scapular neck fracture–the influence of permanent malalignment of the glenoid neck on clinical outcome. Arch Orthop Trauma Surg. 2001;121(6):313–6.

    Article  CAS  PubMed  Google Scholar 

  71. Cole PA, Gauger EM, Herrera DA, Anavian J, Tarkin IS. Radiographic follow-up of 84 operatively treated scapula neck and body fractures. Injury. 2012;43(3):327–33.

    Article  PubMed  Google Scholar 

  72. Anavian J, Khanna G, Plocher EK, Wijdicks CA, Cole PA. Progressive displacement of scapula fractures. J Trauma. 2010;69(1):156–61.

    Article  PubMed  Google Scholar 

  73. Hill BW, Anavian J, Jacobson AR, Cole PA. Surgical management of isolated acromion fractures: technical tricks and clinical experience. J Orthop Trauma. 2014;28(5):e107–13.

    Article  PubMed  Google Scholar 

  74. Mulawka B, Jacobson AR, Schroder LK, Cole PA. Triple and quadruple disruptions of the superior shoulder suspensory complex. J Orthop Trauma. 2014. doi:10.1097/BOT.0000000000000275

  75. Hill BW, Jacobson AR, Anavian J, Cole PA. Surgical management of coracoid fractures: technical tricks and clinical experience. J Orthop Trauma. 2014;28(5):e114–22.

    Article  PubMed  Google Scholar 

  76. Jones CB, Cornelius JP, Sietsema DL, Ringler JR, Endres TJ. Modified Judet approach and minifragment fixation of scapular body and glenoid neck fractures. J Orthop Trauma. 2009;23(8):558–64. doi:10.1097/BOT.0b013e3181a18216.

    Article  PubMed  Google Scholar 

  77. Cole PA, Freeman G, Dubin JR. Scapula fractures. Curr Rev Musculoskeletal Med. 2013;6(1):79–87.

    Article  Google Scholar 

  78. Cole PDJM. Shoulder girdle injuries. In: Stannard JP, editor. Surgical treatment of orthopaedic trauma. New York: Thieme; 2009. p. 207–37.

    Google Scholar 

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Acknowledgment

The authors acknowledge Amir Rizkala, M.D., for the assistance in selecting and preparing the images for this chapter.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Regions Hospital, University of Minnesota, 640 Jackson Street, St. Paul, MN, 55101, USA

    Peter A. Cole M.D., Sara C. Graves M.D., M.S. & Lisa K. Schroder B.S.M.E., M.B.A.

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  1. Peter A. Cole M.D.
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Correspondence to Peter A. Cole M.D. .

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Editors and Affiliations

  1. Division of Orthopedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada

    Michael D. McKee

  2. Division of Orthopedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada

    Emil H. Schemitsch

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Cole, P.A., Graves, S.C., Schroder, L.K. (2015). Management of Associated Injuries (Clavicle and Scapula). In: McKee, M., Schemitsch, E. (eds) Injuries to the Chest Wall. Springer, Cham. https://doi.org/10.1007/978-3-319-18624-5_15

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  • DOI: https://doi.org/10.1007/978-3-319-18624-5_15

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