The relationship between the presence of scapula fracture and mortality and morbidity in cases with blunt thoracic trauma

BACKGROUND: Scapula fractures (SFs) occur as a result of high-energy trauma and are significant in terms of life-threatening injuries. There are few studies showing the relationship between SFs and mortality and morbidity in patients with blunt thoracic trauma (BTT). Our study aims to investigate the relationship between SF and mortality and morbidity in BTT.
METHODS: Adult patients admitted to the emergency department of Kahramanmaras Sutcu Imam University, School of Medicine with BTT between January 2019 and April 2021 were retrospectively scanned from hospital records. Patients’ age, gender, trauma mechanism, additional organ injuries, need for intensive care, length of hospital stay, morbidity, and mortality rates were recorded. Statistical results were expressed as frequency, percentage, and mean±standard deviation (min–max). In comparisons between groups, p<0.05 was accepted as the significance level.
RESULTS: Two hundred and thirty-eight cases were included in our study. The scapular fracture was present in 86 cases (36.1%). About 43% of the cases with SFs were falling from a height. Intrathoracic injuries accompanying SF were determined as rib fracture, lung contusion, pneumothorax, hemothorax, and sternum fracture, respectively (91.9%, 80.2%, 41.9%, 37.2%, and 15.1%). Extrathoracic injuries associated with SF were vertebral fractures, intracranial injuries, clavicle fractures, extremity fractures, and intra-abdominal injuries (18.6%, 16.3%, 12.8%, 10.5%, and 5.8%), respectively. When the groups with and without SF were compared, a statistically significant relationship was found between SF and the number of rib fractures, lung contusion, pneumothorax, and hemothorax (p<0.001, p=0.001, p=0.001, p=0.001). In extrathoracic injuries, there was a significant relationship between SFs and vertebral fractures, intra-cranial injuries, and clavicle fractures (p=0.004, p<0.001, p=0.005). There was no difference observed between the groups regarding sternum fractures, extremity fractures, and intra-abdominal organ injuries (p=0.288, p=0.682, p=0.261). In cases with accompanying SF, there was a significant difference in terms of length of hospital stay, need for intensive care, and mortality (p<0.001, p=0.001, p=0.002).
CONCLUSION: The most common intrathoracic injuries accompanying SFs were rib fractures and lung contusion, and the most common extrathoracic injuries were vertebral fractures and intracranial injuries. Moreover, it was found that SF was highly correlated with length of hospital stay, need for intensive care, and mortality. The most common cause of mortality was found to be intracranial hemorrhage. Imaging of other systems is important in cases with SFs. Particular attention should be paid to head-and-neck injuries.

Künt toraks travmalý olgularda skapula kýrýðý varlýðýnýn mortalite ve morbidite ile iliþkisi

AMAÇ: Skapula kýrýklarý yüksek enerjili travmalar sonucunda meydana gelir ve hayatý tehdit eden yaralanmalara eþlik etmesi bakýmýndan önemlidir. Künt toraks travmalý hastalarda skapula kýrýðýnýn mortalite ve morbidite ile iliþkisini ortaya koyan az sayýda çalýþma bulunmaktadýr. Çalýþmamýzýn amacý künt toraks travmasýnda skapula kýrýðýnýn mortalite ve morbidite ile iliþkisini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Kahramanmaraþ Sütçü Ýmam Üniveristesi Hastanesi Acil Servis’ine Ocak 2019–Nisan 2021 tarihleri arasýnda künt toraks travmasý ile baþvuran eriþkin hastalar hastane kayýtlarýndan geriye dönük olarak tarandý. Hastalarýn yaþý, cinsiyeti, travma mekanizmasý, ek organ yaralanmalarý, yoðun bakým ihtiyacý, hastanede yatýþ süresi, morbidite ve mortalite oranlarý hastane kaydedildi. Ýstatistiksel sonuçlar frekans, yüzde, ortalama±standart sapma (min-maks) olarak ifade edildi. Gruplar arasý karþýlaþtýrmalarda p<0.05 anlamlý kabul edildi.
BULGULAR: Çalýþmamýza 238 olgu alýndý. Seksen altý olguda (%36.1) skapula kýrýðý mevcuttu. Skapula kýrýðý tespit edilen hastalarýn %43’ü yüksekten düþme idi. Buna eþlik eden toraks içi yaralanmalar sýrasýyla kaburga kýrýðý, akciðer kontüzyonu, pnömotoraks, hemotoraks ve sternum kýrýðý olarak tespit edildi (%91.9, %80.2, %41.9, %37.2, %15.1). Skapula kýrýðý ile birliktelik gösteren toraks dýþý yaralanmalar ise sýrasýyla vertebra kýrýklarý, intrakranial yaralanmalar, klavikula kýrýðý, ekstremite kýrýklarý ve karýn içi yaralanmalardý (%18.6, %16.3, %12.8, %10.5, %5.8). Skapula kýrýðýna sahip olan ve olmayan gruplar karþýlaþtýrýldýðýnda, skapula kýrýðý ile kaburga kýrýðý sayýsý, akciðer kontüzyonu, pnömotoraks ve hemotoraks arasýnda istatistiksel olarak anlamlý iliþki saptandý (p<0.001, p<0.001, p<0.001, p<0.001). Toraks dýþý yaralanmalarda ise skapula kýrýðý ile vertebra kýrýklarý, intrakranial yaralanmalar ve klavikula kýrýðý arasýnda anlamlý iliþki izlendi (p=0.004, p<0.001, p=0.005). Sternum kýrýðý, ekstremite kýrýðý ve karýn içi organ yaralanmalarý açýsýndan gruplar arasýnda fark izlenmedi (p=0.288, p=0.682, p=0.261). Skapula kýrýðýnýn eþlik ettiði olgularda hastane yatýþ süresi, yoðun bakým gereksinimi ve mortalite açýsýndan anlamlý fark mevcuttu (p<0.001, p<0.001, p=0.002).
TARTIÞMA: Skapula kýrýklarýna eþlik eden en sýk toraks içi yaralanmalar kaburga kýrýklarý ve akciðer kontüzyonu, toraks dýþý yaralanmalar vertebra kýrýðý ve intrakranial yaralanmalar olarak saptandý. Ayrýca skapula kýrýðýnýn hastanede yatýþ süresi, yoðun bakým ihtiyacý ve mortalite ile yüksek iliþkisi olduðu tespit edildi. En sýk mortalite nedeni ise intrakranial kanama olarak tespit edildi. Skapula kýrýðý tespit edilen olgularda diðer sistemlerin görüntülemesi önemlidir. Özellikle baþ-boyun yaralanmalarý açýsýndan dikkatli olunmalýdýr.