Three-year emergency department analysis of clavicle fractures: Age- and sex-dependent patterns and associated injuries

Background

This study aimed to evaluate the demographic and clinical characteristics of adult patients presenting to the emergency department (ED) with clavicle fractures, describe the distribution of concomitant thoracic injuries, and identify factors independently associated with rib fracture and hemothorax/pneumothorax.

Methods

This single-center retrospective observational study included consecutive adult patients presenting to the ED with acute traumatic clavicle fractures between January 1, 2022, and January 1, 2025. Patients were identified through the Hospital Medical Record System using the ICD-10 code S42.0, and 687 of 828 screened ED encounters were included in the final analysis. Demographic characteristics, injury mechanisms, fracture patterns, associated injuries, treatment approaches, and ED outcomes were retrospectively reviewed. Trauma mechanisms were classified as low-energy or high-energy. Multivariable logistic regression analyses were performed to identify factors associated with rib fracture and hemothorax/pneumothorax.

Results

Of the 687 patients, 85.2% (n=585) were younger than 65 years. High-energy trauma mechanisms and midshaft fractures were more common in younger patients, whereas low-energy trauma with medial/lateral fractures predominated in older patients (p<0.001). Rib fracture (19.7% vs. 7.6%, p=0.005) and hemothorax/pneumothorax (12.4% vs. 3.3%, p=0.009) were significantly more frequent in male patients. Multivariable analysis revealed that increasing age (adjusted odds ratio [aOR]: 1.02, 95% confidence interval [CI]: 1.01–1.03, p<0.001), male sex (aOR: 3.08, 95% CI: 1.29–7.33, p=0.011), high-energy trauma (aOR: 3.28, 95% CI: 1.89–5.70, p<0.001), and medial (sternal) fracture location (aOR: 2.81, 95% CI: 1.11–7.10, p=0.029) were independently associated with rib fracture. For hemothorax/pneumothorax, increasing age (aOR: 1.03, 95% CI: 1.02–1.05, p<0.001) and high-energy trauma (aOR: 8.51, 95% CI: 3.53–20.49, p<0.001) were independently associated.

Conclusion

Clavicle fractures demonstrated varying clinical and traumatic characteristics across different age and sex groups. Increasing age, male sex, high-energy trauma, and medial clavicle fractures were associated with rib fractures, whereas increasing age and high-energy trauma were associated with hemothorax/pneumothorax. Combined evaluation of trauma mechanism, patient characteristics, and fracture pattern may help identify patients at increased risk for concomitant thoracic injuries in the ED.