Multiple Injury

Characteristic

Mean value or %

ISS

31.4 ± 12.4

Age

41.7 ± 20.5

Male

66.0

Blunt trauma

95.7

Mortality

21.7

Table 10.2 presents the percentage of specific locations of fractures reported in the total of 34,049 patients with an ISS of more than 16. Most fractures occurred in the shoulder in 22.9 % of the cases, followed by 10.6 % fractures of the clavicle, 8 % of the humerus and 7.3 % of the scapula.

Table 10.2

Location of fractures, overall collective with 34,049 patients TR-DGU

Location of fracture	Percentage all patients (%)
Shoulder	22.9
Clavicle	10.6
Humerus	8.0
Scapula	7.3

The percentage of concomitant fracture locations of 2,709 patients with a humeral fracture are shown in Table 10.3. The most common type of fracture were fractures of the radius in 18.3 % of cases, followed by fractures of the ulna in 13.8 % of patients, 11.9 % of clavicular fractures, 10.8 % of scapula fractures and 5.3 % fractures of the hand.

Table 10.3

Humeral fracture and concomitant fractures, n = 2,709 (8 %) cases with humeral fractures

Location of fracture	Percentage of concomitant injuries of the upper extremity (%)
Radius	18.3
Ulna	13.8
Clavicle	11.9
Scapula	10.8
Hand	5.3

Table 10.4 summarizes the injury patterns of all patients with humeral fractures. Most common were injuries of the chest in 67.7 % of cases. Injuries of the extremities were reported in 62.8 % of cases, 50.1 % head injuries and 25.6 % of abdominal injuries (only AIS ≥3 injuries, AIS = Abbreviated Injury Scale).

Table 10.4

Injury pattern, overall collective 34,049 patients TR-DGU

Location of injury	%
Head AIS ≥3	50.1
Chest AIS ≥3	67.7
Abdominal AIS ≥3	25.6
Extremities AIS ≥3	32.8

AIS Abbreviated Injury Scale

Table 10.5 shows that 15.4 % of humeral fractures were open fractures, 69.2 % were treated surgically and 17.0 % were treated with external fixators. Overall, 1.6 surgical interventions were necessary in the treatment of humeral fractures.

Table 10.5

Basic therapeutic data, n = 2,709 patients with humeral fractures

Treatment	%
Open fracture	15.4
Operative treatment	69.2
External fixators	17.0
Number of necessary humeral operations on average	1.6

Discussion

We present epidemiological data in a polytrauma collective with humeral fractures. Compared to other recorded trauma populations, where the mean age was 37.5 years with a majority of men (67.5 %) and mean ISS of 34.3 [24], our data showed very similar findings with a mean age of 41.7 years, mean ISS of 31.4 as well as mainly male patients (66.0 %).

As known from several studies, the mean age for proximal humeral fractures generally is higher and related to low energy trauma in elderly women, whereas the age relatively decreases in multiple trauma patients which are also mainly male.

In our analysis, humeral fractures were recorded in 8 % of all patients with severe trauma and ISS greater than 16 which is a similar percentage as found by Banerjee et al. According to their data, humeral fractures occurred in 7.4 % of all major trauma patients [18].

In our analysis, the most common additional fracture in patients with humeral fractures is the radius fracture, followed by fractures of the ulna. Chest injuries were the most frequently observed injured body region, similar to findings by Banerjee et al., where patients with extremity injury often showed severe chest trauma [18]. Bell et al. report about femur fractures being the most commonly associated fracture in patients with humeral fractures [19].

Regel et al reported that 86 % of multiple injured showed extremity injuries [21], compared to 62.8 % injuries of extremities in our collective.

We observed a general mortality of 21.7 % compared to 5.0 % reported by Clement et al. in patients with humeral fractures that showed multiple fractures [10].

The diagnostic and therapeutic effort in patients with multiple injuries is especially demanding. The average number of necessary operations for humeral fractures in our collective was 1.6.

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