• Tobias Helfen, Stephan Jansen, Evi Fleischhacker, Wolfgang Böcker, Stefan Wirth, and Ben Ockert.
• Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Campus Innenstadt, Nußbaumstr. 20, 80336, Munich, Germany. tobias.helfen@med.uni-muenchen.de.
• Eur J Trauma Emerg Surg. 2021 Oct 1; 47 (5): 1399-1406.

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 = 61 patients. The mean ISS was 13.5 ± 17, n = 13 (21.3%) cases were classified as "severely injured" (ISS ≥ 16). N = 29 (47.5%) achieved an initial X-ray, n = 10 (16.4%) an initial CT scan of the sternoclavicular region, and n = 22 (36%) an initial whole-body CT scan. Initial imaging correlated significantly with ISS. In n = 21 (72.4%) cases of the X-ray group a significant complement from X-ray to CT scan of the sternoclavicular region was indicated (p ≤ 0.001). N = 31 (50.8%) patients suffered from concomitant injuries. N = 39 (63.9%) of all patients underwent any kind of surgery, thereof n = 23 (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.© 2019. Springer-Verlag GmbH Germany, part of Springer Nature.

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