Hefny Ashraf F, Mansour Nirmin A, Hefny Mohamed A, Masuadi Emad, Al Bahri Shadi, Elkamhawy Ashraf A, Saber Khalid S
Department of Surgery, College of Medicine and Health Sciences, UAE University, Al Ain, UAE.
Ambulatory Health Services, Abu Dhabi Health Services Company, Abu Dhabi, UAE.
Surg Res Pract. 2024 May 20;2024:3550087. doi: 10.1155/2024/3550087. eCollection 2024.
Scapular fracture is a rare encounter in blunt trauma patients. The scapula is surrounded by strong groups of muscles offering good protection for the bone. Therefore, a high-energy trauma is needed to cause a scapular fracture. We aim to study scapular fractures and their relation to injury severity and mortality in blunt chest trauma (BCT) patients.
We retrospectively collected data from all patients with BCT who were admitted to our hospital from December 2014 through January 2017. The injury details of all BCT patients were retrieved from the trauma registry of the hospital and were supplemented by patients' electronic files for missing information. Collected data included demography, mechanism of injury, vital signs, Glasgow Coma Score (GCS) on admission, injured body regions, management, Injury Severity Score (ISS), New Injury Severity Score (NISS), length of hospital stay (LOS), and mortality.
During the study period, 669 patients had BCT. Scapular fracture was present in 29 (4.3%) of the BCT patients. The scapular fracture was missed by chest X-ray in 35.7% of the patients; however, it was accurately diagnosed by computed tomography (CT) scan of the chest. Neck injury was significantly higher in patients with scapular fracture compared with patients without fracture ( < 0.001). ISS and NISS were significantly higher in patients with scapular fractures compared to other patients without fractures (=0.04 and =0.003 Mann-Whitney test, respectively). Two patients with scapular fractures died due to severe associated injuries (the overall mortality was 9.6%).
Scapular fracture in BCT patients indicates a high-energy type of trauma. Compared to a chest X-ray, CT scan was more accurate for the diagnosis of scapular fracture. Associated injuries are the main cause of trauma-related mortality rather than the direct effect of the fractured scapula. Particular attention and meticulous evaluation should be paid to head and neck injuries to avoid missing injuries.
肩胛骨骨折在钝性创伤患者中较为少见。肩胛骨被强大的肌群环绕，对骨骼提供了良好的保护。因此，需要高能量创伤才能导致肩胛骨骨折。我们旨在研究钝性胸部创伤（BCT）患者的肩胛骨骨折及其与损伤严重程度和死亡率的关系。
我们回顾性收集了2014年12月至2017年1月期间我院收治的所有BCT患者的数据。所有BCT患者的损伤细节均从医院创伤登记处获取，并通过患者电子病历补充缺失信息。收集的数据包括人口统计学、损伤机制、生命体征、入院时格拉斯哥昏迷评分（GCS）、受伤身体部位管理、损伤严重程度评分（ISS）、新损伤严重程度评分（NISS）、住院时间（LOS）和死亡率。
在研究期间，669例患者发生了BCT。29例（4.3%）BCT患者存在肩胛骨骨折。35.7%的患者胸部X线检查漏诊了肩胛骨骨折；然而，胸部计算机断层扫描（CT）准确诊断了该骨折。与无骨折患者相比，肩胛骨骨折患者的颈部损伤明显更高（<0.001）。与其他无骨折患者相比，肩胛骨骨折患者的ISS和NISS明显更高（分别为=0.04和=0.003，曼-惠特尼检验）。2例肩胛骨骨折患者因严重合并伤死亡（总死亡率为9.6%）。
BCT患者的肩胛骨骨折表明为高能量类型的创伤。与胸部X线相比，CT扫描对肩胛骨骨折的诊断更准确。合并伤是创伤相关死亡的主要原因，而非肩胛骨骨折的直接影响。应特别关注并仔细评估头颈部损伤，以避免漏诊。
