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

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.

Fig 1. Prism of distribution of shoulder girdle injuries relating to the clavicle, 2012–2014.

n = number of patients.

Fig 2. Concomitant injuries of medial clavicle and lateral clavicle injuries categorized by the anatomical region.

MCI = medial clavicle injuries; LCI = lateral clavicle injuries; * = significant difference.

Fig 3. Concomitant injuries of medial clavicle injuries categorized by the anatomical region affected.

S43.2 = sternoclavicular joint dislocation; S42.01 = medial clavicle fracture; *p = p-value as level of significant difference.

Fig 4. Most common concomitant injuries of medial clavicle injuries as a main diagnosis.

Second diagnoses according to MCI as a main diagnosis presented as the five most common second diagnoses for both types of MCI each. S43.2 = sternoclavicular joint dislocation; S42.01 = medial clavicle fracture; x = non-valid, since main ≠ secondary diagnosis at the same time.

Fig 5. Prism of medial clavicle injuries therapies coded by OPS code, 2012–2014.

MCI = medial clavicle injuries; SCJ = sternoclavicular joint; n = number of patients.

Fig 6. Primary operations with osteosynthesis of medial clavicle injuries sorted for type of osteosynthesis.

Primary operations with osteosynthesis in the case of the coded diagnosis of a medial clavicle injury (S42.01 and S43.2) related to the sternoclavicular joint, clavicle or others sorted for the type of osteosynthesis. The number is presented as a percentage of all surgeries performed with osteosythesis. All types showed a significant difference between both diagnoses. S43.2 = sternoclavicular joint dislocation; S42.01 = medial clavicle fracture; * = p-value as level of significance with p < 0.001.