Chalidis B, Davitis V, Papadopoulos P, Pitsilos C. Subclavian vessels injury: An underestimated complication of clavicular fractures. World J Crit Care Med 2024; 13(4): 98579 [DOI: 10.5492/wjccm.v13.i4.98579]
Corresponding Author of This Article
Byron Chalidis, MD, PhD, Assistant Professor, First Orthopaedic Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G Papanikolaou Hospital Exohi, Thessaloniki 57010, Greece. byronchalidis@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Byron Chalidis, First Orthopaedic Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
Vasileios Davitis, Pericles Papadopoulos, Charalampos Pitsilos, Second Orthopaedic Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54635, Greece
Author contributions: Chalidis B and Pitsilos C designed the research; Pitsilos C and Davitis V analyzed the data; Chalidis B, Davitis V and Pitsilos C wrote the paper; Chalidis B and Papadopoulos P supervised the paper; all of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Byron Chalidis, MD, PhD, Assistant Professor, First Orthopaedic Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G Papanikolaou Hospital Exohi, Thessaloniki 57010, Greece. byronchalidis@gmail.com
Received: June 29, 2024 Revised: September 4, 2024 Accepted: September 9, 2024 Published online: December 9, 2024 Processing time: 123 Days and 12.6 Hours
Abstract
Clavicle fractures are frequent orthopedic injuries, often resulting from direct trauma or a fall. Most clavicle fractures are treated conservatively without any complications or adverse effects. Concomitant injuries of the subclavian vein or artery are rarely encountered and most commonly associated with high-energy trauma or comminuted clavicle fractures. They are potentially life-threatening conditions leading to hemorrhage, hematoma, pseudoaneurysm or upper limb ischemia. However, the clinical presentation might be obscure and easily missed, particularly in closed and minimally displaced clavicular fractures, and timely diagnosis relies on early clinical suspicion. Currently, computed tomography angiography has largely replaced conventional angiography for the assessment of subclavian vessel patency, as it demonstrates high accuracy and temporal resolution, acute turnaround time, and capability of multiplanar reconstruction. Depending on the hemodynamic stability of the patient and the severity of the injury, subclavian vessel lesions can be treated conservatively with observation and serial evaluation or operatively. Interventional vascular techniques should be considered in patients with serious hemorrhage and limb ischemia, followed by stabilization of the displaced clavicle fracture. This review aims to provide a comprehensive overview of the incidence, clinical presentation, diagnostic approaches, and current management strategies of clavicle fractures associated with subclavian vessel injuries.
Core Tip: Clavicle fractures complicated by vascular injuries are rare and potentially life-threatening conditions. Diagnosis of subclavian vessel injuries might be substantially delayed due to the overshadowing presence of the more obvious fracture symptoms and pain. Sound knowledge of the anatomy, better understanding of the severity of injury and fracture pattern and thorough clinical examination are important to raise the suspicion of a vascular injury and optimize medical care. Clavicle fractures combined with subclavian vessel injuries that are associated with serious hemorrhage or limb ischemia should be addressed operatively to restore vascular continuity and upper limb function. Future research should aim at optimizing diagnostic protocols and exploring advanced therapeutic techniques to enhance patient care in these complex cases.
