Combined injuries of the clavicle and chest wall: modern views on diagnosis and treatment
DOI:
https://doi.org/10.32782/2415-8127.2025.71.2Keywords:
polytrauma, combined fractures of the clavicle and ribs, conservative and surgical treatment, problematic issues, and promising solutionsAbstract
Thoracic trauma is a common injury resulting from high-energy mechanical impact and occurs both in isolated form and in the form of combined multiple traumas. In patients with multiple injuries who sustained blunt chest trauma, the most common injuries are rib fractures (86%), clavicle fractures (19%) or a combination of these injuries (19%). Clavicle fractures are associated with various injuries and complications, which are divided into skeletal and non-skeletal injuries. In particular, non-skeletal injuries are manifested by trauma to the lungs, pleura, ribs, adjacent vessels and brachial plexus. More than 75% of patients with polytrauma with clavicle fractures have concomitant chest injuries. Both injuries are considered indicators of the severity of thoracic trauma and independently increase the risk of mortality due to significant complications as they are directly accompanied by damage to vital structures of the chest with all the negative consequences. The tactics of treatment of combined clavicle and rib fractures have not yet been determined, there are no clear recommendations on the method of treatment, indications for surgical treatment, and evaluation of their effectiveness. Objective: to determine the current tactics of treatment of combined clavicle and chest injuries by analysing the current world literature. Surgical and conservative treatment of combined clavicle and rib fractures have their own focus and advantages, so it is necessary to change the wrong concept from the past, which is to oppose them.Surgical treatment of clavicle fractures significantly reduces the incidence of nonunion, restores the anatomical parameters of the clavicle, which ensures full shoulder joint motion and shortens the consolidation period. Over the past decade, surgical reconstruction of chest wall stability has become increasingly important. The choice of indications, timing of surgical intervention, fixation methods, surgical approaches, fixation structures, as well as means and methods of conservative treatment should be applied in accordance with the specific circumstances and needs of the patient, which will significantly improve treatment outcomes and quality of life.
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