Subclavian arterial injury associated with clavicle fracture
Main Article Content
Abstract
Reports on clavicle fractures with subclavian artery injury have been rare. Damage to vessels may result in threatening limb perfusion and potentially devastating hemorrhage. There should be an accurate diagnosis in order to prevent delays in management and subsequent complications. This research aimed to evaluate the pattern of subclavian artery damage due to the clavicle fracture. A 10-year retrospective analysis from a level one trauma center between 2012 and 2021. We treated 1054 cases with clavicle fractures. The frequency of subclavian arterial injury associated with clavicle fracture was 0.85%. Our data’s findings revealed typical clinical indicators that signify subclavian artery injury. Most patients initially had ischemic symptoms (77.8%). The most common type of injury (71.42%) was the Allman’s classification group I fracture or midshaft fracture with displacement. The common associated lesions were brachial plexus injuries (100%), rib fracture (66.66%), pneumohemothorax (44.44%), and scapular fracture (44.44%). As a minimally invasive therapeutic option, endovascular management is a good substitute for traditional surgical procedures. A high index of clinical suspicion combined with the correlation of associated physical findings is the primary diagnosis for subclavian arterial injury.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Antabak A, Matković N, Papeš D, Karlo R, Romić I, Fuchs N, et al. Clavicle fractures in children - circumstances and causes of injury. Lijec Vjesn. 2015;137(5-6):163-167.
Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elbow Surg. 2002;11(5):452-456.
Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res. 1994;(300):127-132.
Paladini P, Pellegrini A, Merolla G, Campi F, Porcellini G. Treatment of clavicle fractures. Transl Med UniSa. 2012;2:47-58.
Katras T, Baltazar U, Rush DS, Davis D, Bell TD, Browder IW, et al. Subclavian arterial injury associated with blunt trauma. Vasc Surg. 2001;35(1):43-50.
Clitherow HD, Bain GI. Major neurovascular complications of clavicle fracture surgery. Shoulder Elbow. 2015;7(1):3-12.
Demetriades D, Asensio JA. Subclavian and axillary vascular injuries. Surg Oncol Clin N Am. 2001;81(6):1357-1373.
Liu JL, Li JY, Jiang P, Jia W, Tian X, Cheng ZY, et al. Literature review of peripheral vascular trauma: is the era of intervention coming? Chin J Traumatol. 2020;23(1):5-9.
Sciarretta JD, Asensio JA, Vu T, Mazzini FN, Chandler J, Herrerias F, et al. Subclavian vessel injuries: difficult anatomy and difficult territory. Eur J Trauma Emerg Surg. 2011;37(5):439-449.
Collinge CA, Watson K. Clavicle fractures. In: Sanders R, editor. Core knowledge in orthopaedics: trauma. Philadelphia: Elsevier; 2007. p. 68-78.
Elkbuli A, Kinslow K, Dowd B, McKenney M, Boneva D, Whitehead J. Subclavian artery injury secondary to blunt trauma successfully managed by median sternotomy with supraclavicular extension: a case report and literature review. Ann Med Surg. 2020;54:16-21.
Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br. 1997;79-B(4):537-538.
Natali J, Maraval M, Kieffer E, Petrovic P. Fractures of the clavicle and injuries of the sub-clavian artery. Report of 10 cases. J Cardiovasc Surg (Torino). 1975;16(5):541-547.
Katras T, Baltazar U, Rush DS, Davis D, Bell TD, Browder IW, et al. Subclavian arterial injury associated with blunt trauma. Vasc Surg. 2001;35(1):43-50.
Miserocchi G. Physiology and pathophysiology of pleural fluid turnover. Eur Respir J. 1997;10(1):219-225.
McCullough AL, Haycock JC, Forward DP, Moran CG. Early management of the severely injured major trauma patient. Br J Anaesth. 2014;113(2):234-241.
Hyre CE, Cikrit DF, Lalka SG, Sawchuk AP, Dalsing MC. Aggressive management of vascular injuries of the thoracic outlet. Vasc Surg. 1998;27(5):880-885.
Faisham WI, Mohammad P, Juhara H, Munirah NM, Shamsulkamaruljan H, Ziyadi GM. Clavicle fracture and subclavian vessels disruption with massive haemothorax mimic intrathoracic injury. Malays J Med Sci. 2011;18(2):74-77.
Feliciano DV, Moore FA, Moore EE, West MA, Davis JW, Cocanour CS, et al. Evaluation and management of peripheral vascular injury. Part 1. Western trauma association/critical decisions in trauma. J Trauma. 2011;70(6):1551-1556.
Ditsuwan V, Veerman LJ, Barendregt JJ, Bertram M, Vos T. The national burden of road traffic injuries in Thailand. Popul Health Metr. 2011;9:1-9.
Robinson CM. Fractures of the clavicle in the adult: epidemiology and classification. J Bone Joint Surg Br. 1998;80-B(3):476-484.
Raviraja A, Chandrashekar CM, Roshan SD, Srinivas JV. Subclavian artery and vein injury following clavicle fracture due to blunt trauma. Injury Extra. 2009;40(2):36-38.
McCready RA, Procter CD, Hyde GL. Subclavian-axillary vascular trauma. J Vasc Surg. 1986;3(1):24-31.
Hendey GW, Ling LJ, Rosen CL, Schaider J, Sharieff GQ. Harwood-Nuss’ clinical practice of emergency medicine. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2009.
Assenza M, Centonze L, Valesini L, Campana G, Corona M, Modini C. Traumatic subclavian arterial rupture: a case report and review of the literature. World J Emerg Surg. 2012;18;7(1):18.
Alam HB, DiMusto PD. Management of lower extremity vascular trauma. Curr Trauma Rep. 2015;1(1):61-68.
Tadayon N, Yavari N, Zarrintan S, Hosseini SM, Kalantar-Motamedi SMR. Management of traumatic subclavian artery injuries in a high-volume vascular surgery center in Iran. J Cardiovasc Thorac Res. 2020;12(2):145-149.
Langer V. Management of major limb injuries. Sci World J. 2014;2014:1-13.
Tanmit P, Angkasith P, Teeratakulpisarn P, Thanapaisal C, Wongkonkitsin N, Prasertcharoensuk S, et al. treatment outcome of traumatic subclavian artery injuries. Vasc Health Risk Manag. 2021;17:481-1487.
Stockinger ZT, Townsend MC, McSwain NE, Hewitt RL. Acute endovascular management of a subclavian artery injury. J La State Med Soc. 2004;156(5):262-264.