Pneumothorax After Clavicle Fixation: Do We Need Intraoperative - - PowerPoint PPT Presentation

▶

Jan 03, 2023 417 likes •607 views

Pneumothorax After Clavicle Fixation: Do We Need Intraoperative Chest X-Ray? M. Kareem Shaath, MD; Joseph A. Ippolito, MD; Michael S. Sirkin, MD; Mark C. Reilly, MD; Mark R. Adams, MD Rutgers University New Jersey Medical School Department

SLIDE 1

Pneumothorax After Clavicle Fixation: Do We Need Intraoperative Chest X-Ray?

M. Kareem Shaath, MD; Joseph A. Ippolito, MD; Michael
S. Sirkin, MD; Mark C. Reilly, MD; Mark R. Adams, MD

Rutgers University – New Jersey Medical School Department of Orthopaedic Surgery

SLIDE 2

Introduction

Approximately 5% of all fractures
Greater than 50% of shoulder girdle injuries1,2
Pneumothorax is a dreaded complication

– Rare, incidence unknown – Less than 10 cases in English literature1-8 – Increased risk with superior plating

SLIDE 3

Purpose

Identify risk factors for pre-operative or post-operative

pneumothorax in patients undergoing ORIF of the clavicle

Assess the value, of an intraoperative chest x-ray, (CXR)

SLIDE 4

Methods

IRB approval obtained
162 consecutive patients reviewed from 2006-2016
11 Patients with pre-operative pneumothorax excluded
Patients divided into 2 groups:

– Intraoperative CXR (IO) – Postoperative CXR (PO)

Data Collected:

– Age – BMI – Time to Fixation – Mechanism of Injury – OTA Fracture Classification – Method of Fixation – Presence/Abscenece of Postoperative Pneumothorax

SLIDE 5

Results

SLIDE 6

Demographics

IO PO p Gender Female 16 Male 52 Female 21 Male 61 0.73 Age 35.6+1.8 34.8+1.5 0.72 BMI 26.0+0.6 26.2+0.6 0.84 Time to Fixation 8.1+3.0 9.5+1.8 0.69

SLIDE 7

Mechanism of Injury

Mechanism IO PO p Assault 3 3 0.263 Cyclist 3 2 Fall 25 31 MCC 6 17 MVC 13 17

Ped. Struck

10 6 Sports 4 4 Unknown 4 2 Total 68 82

SLIDE 8

Fracture Location (OTA)

15 IO PO p Medial (A) 1 0.547 Diaphyseal (B) 61 73 Distal (C) 6 8

SLIDE 9

Fracture Configuration (OTA)

15-B IO PO p value Noncomminuted (1) 21 29 0.547 Wedge (2) 31 29 Segmental (3) 9 15

SLIDE 10

Method of Fixation

Method of Fixation IO PO p Anterior 24 35 0.532 Superior 17 32 Ant/Superior 23 6 Inferior 3 6 IM Nail 1 Distal Clavicle Plate 1 2 Total 68 82

SLIDE 11

Pneumothorax?

No patients in our population experienced a intraoperative

pneumothorax

12 patients with existing pneumothorax, did not have a

worsening of condition

Rib fracture at presentation with concomitant clavicle

fracture increased risk for pneumothorax (p<.00001)

– OR 61.7

SLIDE 12

Intraoperative CXR by Subspecialty

Subspecialty IO PO p Trauma 57 51 .0007 Hand 2 16 Sports 9 12 Pediatrics 2 Oncology 1 Total 68 82

SLIDE 13

SLIDE 14

Operative Time

Mean time from incision closure to leaving the operating room

was prolonged by 18.9 + 1.9 minutes in the IO group (p<.0001)

Prolonged time under anesthesia

– Anesthesia costs $15-20/minute9

Additional $285-380

– OR charges average of $62/minute ($22-133/min)9

$1,178 ($418-2,527)
Delays room turnover
Increased healthcare costs

SLIDE 15

Conclusion

None of the patients developed a post-operative pneumothorax
Orthopaedic traumatologists are more likely to obtain intraoperative

CXR

If a patient has concomitant rib fractures, increased suspicion for

pneumothorax at presentation

Intraoperative CXR should only be obtained only if there is a

clinical suspicion for pneumothorax intraoperatively minimizing potential risks of prolonged time under anesthesia and increased healthcare costs.

SLIDE 16

References

1. Yates DW. Complications of fractures of the clavicle. Injury. 1976 Feb;7(3):189-93. 2. Khan LA, Bradnock TJ, Scott C, Robinson CM. Fractures of the clavicle. J Bone Joint Surg Am. 2009 Feb;91(2):447-60. 3. Meeks RJ, Riebel GD. Isolated clavicle fracture with associated pneumothorax: a case report. Am J Emerg Med. 1991 Nov;9(6):555-6. 4. Dath R, Nashi M, Sharma Y, Muddu BN. Pneumothorax complicating isolated clavicle fracture. Emerg Med J. 2004 May;21(3):395-6. 5. Steenvoorde P, van Lieshout AP, Oskam J. Conservative treatment of a closed fracture of the clavicle complicated by pneumothorax: a case report. Acta Orthop Belg. 2005 Aug;71(4):481-3. 6. Gandham S, Nagar A. Delayed pneumothorax following an isolated clavicle injury. BMJ Case Rep. 2013;2013. 7. van Laarhoven JJ, Ferree S, Houwert RM, Hietbrink F, Verleisdonk EM, Leenen LP. Demographics of the injury pattern in severely injured patients with an associated clavicle fracture: a retrospective observational cohort study. World J Emerg Surg. 2013;8(1):36. 8. Skedros JG, Knight AN, Mears CS, Langston TD. Temporary sternoclavicular plating for an unusual double clavicle fracture (medial nonunion, lateral acute) complicated by an intraoperative pneumothorax. Case Rep Orthop. 2014;2014:206125. 9. Macario, A. (2010). What does one minute of operating room time cost? Journal of Clinical Anesthesia, 22(4), 233-236.

SLIDE 17