• van Laarhoven J J E M JJEM Department of Trauma, University Medical Center Utrecht, Heidelberglaan 100, Suite G04.228, 3584 CX, Utrecht, The Netherlands. jjemvanlaarhoven, F Hietbrink, S Ferree, A C Gunning, R M Houwert, Verleisdonk E M M EMM Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands., and Leenen L P H LPH Department of Trauma, University Medical Center Utrecht, Heidelberglaan 100, Suite G04.228, 3584 CX, Utrecht, The Netherlands..
• Department of Trauma, University Medical Center Utrecht, Heidelberglaan 100, Suite G04.228, 3584 CX, Utrecht, The Netherlands. jjemvanlaarhoven@gmail.com.
• Eur J Trauma Emerg Surg. 2019 Feb 1; 45 (1): 59-63.

PurposeDuring primary survey the main goal is to ascertain life-threatening injuries. A chest X-ray is recommended in all polytrauma patients as thoracic injury plays an important role in mortality. However, treatment-dictating injuries are often missed on the chest X-ray. In contrast, clavicle fractures should be relatively easy to diagnose on a chest X-ray. We previously showed that clavicle fractures occur in approximately 10 % of all polytrauma patients in our population. The aim was to compare polytrauma patients, with and without a clavicle fracture, to investigate if a clavicle fracture is associated with concomitant thoracic injury.MethodsA retrospective cohort study of polytrauma patients (ISS ≥ 16) from 2007 until 2011. Thoracic injuries were defined as: ribfracture, pneumothorax, lung contusion, sternum fracture, hemothorax, myocardial contusion, thoracic aorta injury and thoracic spine injury.ResultsOf 1461 polytrauma patients in 160 patients a clavicle fracture was diagnosed, and 95 % was diagnosed on chest X-ray. Patients with a clavicle fracture had a higher mean Injury Severity Score (ISS) (29.2 ± 10.1 vs. 24.9 ± 9.1; P < 0.001). Additional thoracic injuries were more prevalent in patients with a clavicle fracture (76 vs. 47 %; OR 3.6; 95 % CI 2.45-5.24) and they had a higher rate of thoracic injury with an AIS ≥ 3 (66 vs. 41 %; OR 2.8; 95 % CI 1.97-3.93).ConclusionsThe clavicle can be seen as the gatekeeper of the thorax. In polytrauma patients, a clavicle fracture is easily diagnosed during primary survey and may indicate underlying thoracic injury, as the rate and extent of concomitant thoracic injury are high.

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