Association of Ipsilateral Rib Fractures With Displacement of Midshaft Clavicle Fractures

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Abstract

Objectives:

To determine whether the presence of ipsilateral rib fractures affects the rate of a clavicle fracture being unstable (>100% displacement).

Design:

A retrospective review from 2002–2013 performed at a single level 1 trauma center evaluated 243 midshaft clavicle fractures.

Setting:

Single Level 1 trauma center.

Patients/Participants:

These fractures were subdivided into those with ipsilateral rib fractures (CIR; n = 149) and those without ipsilateral rib fractures (CnIR; n = 94).

Intervention:

The amount of displacement was measured on the initial injury radiograph and subsequent follow-up radiographs.

Main Outcome Measurements:

Fractures were classified into either <100% displacement or >100% displacement, based on anteroposterior radiographs. Ipsilateral rib fractures were recorded based on which number rib was fractured and the total number of fractured ribs.

Results:

One hundred sixteen (78%) of the CIR group and 51 (54%) of the CnIR group were found to have >100% displacement at follow-up (P = 0.0047). Seventy-two percent of the CIR group demonstrated progression from <100% to >100% displacement of the fracture compared with only 54% of the CnIR group (P < 0.05). The odds ratio for progression of the clavicle fracture to >100% was 4.08 (P = 0.000194) when ribs 1–4 were fractured and not significant for rib fractures 5–8 or 9–12.

Conclusions:

The presence of concomitant ipsilateral rib fractures significantly increases the rate of midshaft clavicle fractures being >100% displaced. In addition, a fracture involving the upper one-third of the ribs significantly increases the rate of the clavicle fracture being >100% displaced on early follow-up. Clavicle fractures with associated ipsilateral rib fractures tend to demonstrate an increased amount of displacement on follow-up radiographs compared with those without ipsilateral rib fractures.

Level of Evidence:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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