Injuries of the sternoclavicular region indicate concomitant lesions and need distinguished imaging

Abstract

PurposeTo evaluate injuries of the sternoclavicular region as indicator injury for relevant concomitant injuries and to evaluate the modalities of initial imaging. We hypothesised a high incidence of concomitant injuries as well as a deficiency of X-ray as the initial gold standard.MethodsWe retrospectively analysed patients suffering from injuries of the sternoclavicular region between 2002 and 2017. We analysed amongst injury type and severity, initial imaging (X-ray vs. CT scan of the sternoclavicular region vs. whole-body scan), and complement of imaging with regard to defined concomitant injury localisations and the resulting necessity and urgency of surgery.ResultsWe included n\u2009=\u200961 patients. The mean ISS was 13.5\u2009±\u200917, n\u2009=\u200913 (21.3%) cases were classified as “severely injured” (ISS\u2009≥\u200916). N\u2009=\u200929 (47.5%) achieved an initial X-ray, n\u2009=\u200910 (16.4%) an initial CT scan of the sternoclavicular region, and n\u2009=\u200922 (36%) an initial whole-body CT scan. Initial imaging correlated significantly with ISS. In n\u2009=\u200921 (72.4%) cases of the X-ray group a significant complement from X-ray to CT scan of the sternoclavicular region was indicated (p\u2009≤\u20090.001). N\u2009=\u200931 (50.8%) patients suffered from concomitant injuries. N\u2009=\u200939 (63.9%) of all patients underwent any kind of surgery, thereof n\u2009=\u200923 (37.7%) related to their sternoclavicular injuries.ConclusionInjuries of the sternoclavicular complex are indicators for the presence of multiple injuries. A CT scan of the sternoclavicular region including ipsilateral apex of the lung and upper rib cage comprised a large proportion of concomitant injuries. Mapping those injuries during initial imaging improves treatment process, avoids underdiagnostic, and decreases uncertainties.