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Some authors associate CF with a higher degree of chest injuries; therefore, the clavicle is meant to be a gatekeeper of the thorax.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A retrospective analysis of the TraumaRegister DGU<jats:sup>\u00ae<\/jats:sup> (project 2017-10) was carried out involving the years 2009\u20132016 (ISS\u2009\u2265\u200916, primary admission to a trauma center). Cohort formation: unilateral and bilateral flail chest injuries (FC), respectively, with and without a concomitant CF.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>73,141 patients (26.5% female) met the inclusion criteria and 12,348 had flail chest injuries (FC; 20.0% CF; 67.7% monolateral FC), 25,425 other rib fractures (17.7% CF), and 35,368 had no rib fractures (6.5% CF). On average, monolateral FC patients were 56.0\u2009\u00b1\u200917.9\u00a0years old and bilateral FC patients were 57.7\u2009\u00b1\u200919\u00a0years old. The ISS in unilateral and bilateral FC were 29.1\u2009\u00b1\u200911.7 and 42.2\u2009\u00b1\u200912.9 points, respectively. FC with a CF occurred more frequently with bicycle and motorbike injuries in monolateral FC and pedestrians in bilateral FC injuries and less frequently due to falls. Patients with a CF in addition to a FC had longer hospital and ICU stays, underwent artificially respiration for longer periods, and died less often than patients without a CF. The effects were highly significant in bilateral FC. CF indicates more relevant concomitant injuries of the lung, scapula, and spinal column. Moreover, CF was associated with more injuries of the extremities in monolateral CF.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Due to the relevance of a concomitant CF fracture in FC, diagnostics should focus on finding CFs or rule them out. Combined costoclavicular injuries are associated with a significantly higher degree of thoracic injuries and longer hospital stays.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00068-021-01819-5","type":"journal-article","created":{"date-parts":[[2021,11,5]],"date-time":"2021-11-05T12:02:32Z","timestamp":1636113752000},"page":"3623-3634","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["The significance of a concomitant clavicle fracture in flail chest patients: incidence, concomitant injuries, and\u00a0outcome of 12,348 polytraumata from the TraumaRegister DGU\u00ae"],"prefix":"10.1007","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2448-2150","authenticated-orcid":false,"given":"Mustafa Sinan","family":"Bakir","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Langenbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melina","family":"Pinther","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf","family":"Lefering","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Krinner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Grosso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Ekkernkamp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Schulz-Drost","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the TraumaRegister DGU","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,11,5]]},"reference":[{"issue":"6","key":"1819_CR1","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1097\/SLA.0b013e3182895bb0","volume":"258","author":"JA Leinicke","year":"2013","unstructured":"Leinicke JA, Elmore L, Freeman BD, Colditz GA. 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Eur J Trauma Emerg Surg. 2020. https:\/\/doi.org\/10.1007\/s00068-019-01293-0.","journal-title":"Eur J Trauma Emerg Surg"}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-021-01819-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-021-01819-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-021-01819-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,4]],"date-time":"2022-10-04T18:07:03Z","timestamp":1664906823000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00068-021-01819-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,5]]},"references-count":40,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,10]]}},"alternative-id":["1819"],"URL":"https:\/\/doi.org\/10.1007\/s00068-021-01819-5","relation":{},"ISSN":["1863-9933","1863-9941"],"issn-type":[{"value":"1863-9933","type":"print"},{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,5]]},"assertion":[{"value":"17 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 October 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 November 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The senior author S. Schulz-Drost is a member of the AO TK Thoracic Surgery Expert Group (THEG), he has a consultant agreement with DePuySynthes and he is working for the national DSTC\u2122 program. Sebastian Krinner has a consultant agreement with Stryker. Sinan Bakir, Andreas Langenbach, Melina Pinther, Rolf Lefering, Marco Grosso and Axel Ekkernkamp state that they are not involved in any conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All data were collected anonymously and the study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Due to the retrospective character of the analysis, the given informed consent, the existing ethics vote, and the international character of the registry, no additional approval from local ethics committee was necessary (University Hospital Erlangen, Ethics Committee).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Written informed consent was obtained from\u00a0all patients, their parents, or a legal guardian.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"All patients, their parents, or a legal guardian gave their informed written consent for publishing data.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}