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Blunt traumatic scapular fractures are associated with great vessel injuries in children

Abd el-shafy, Ibrahim MD; Rosen, Lisa M. ScM; Prince, Jose M. MD; Letton, Robert W. MD; Rosen, Nelson G. MD

Journal of Trauma and Acute Care Surgery: November 2018 - Volume 85 - Issue 5 - p 932–935
doi: 10.1097/TA.0000000000001980

BACKGROUND Patients with stable blunt great vessel injury (GVI) can have poor outcomes if the injury is not identified early. With current pediatric trauma radiation reduction efforts, these injuries may be missed. As a known association between scapular fracture and GVI exists in adult blunt trauma patients, we examined whether that same association existed in pediatric blunt trauma patients.

METHODS Bluntly injured patients younger than 18 years old were identified from 2012 to 2014 in the National Trauma Data Bank. Great vessel injury included all major thoracic vessels and carotid/jugular. Demographics of patients with and without scapular fracture were compared with descriptive statistics. The χ2 test was used to examine this association using SAS Version 9.4 (SAS Institute, Inc, Cary, NC).

RESULTS We found a significant association between pediatric scapular fracture and GVI. Of 291,632 children identified, 1,960 had scapular fractures. Children with scapular fracture were 10 times more likely to have GVI (1.2%) compared to those without (0.12%, p < 0.0001). Most common GVI seen were carotid artery, thoracic aorta, and brachiocephalic or subclavian artery or vein. Children with both scapular fracture and GVI were most commonly injured by motor vehicles (57% collision, 26% struck).

CONCLUSIONS Injured children with blunt scapular fracture have a 10-fold greater risk of having a GVI when compared to children without scapular fracture. Presence of blunt traumatic scapular fracture should have appropriate index of suspicion for a significant GVI in pediatric trauma patients.

LEVEL OF EVIDENCE Epidemiologic and prognostic study, level III; Therapeutic, level IV.

From the Pediatric Trauma Center, Cohen Children’s Medical Center, the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York (I.A.e., J.M.P., N.G.R.); Feinstein Institute for Medical Research, Manhasset, New York (I.A.e., L.M.R., J.M.P., N.G.R.); Maimonides Medical Center, Brooklyn New York (I.A.e.); and Oklahoma University Health Science Center, Oklahoma City, Oklahoma (R.W.L.).

Submitted: January 15, 2018, Revised: March 26, 2018, Accepted: April 15, 2018, Published online: May 22, 2018.

This study was presented at the 48th Western Trauma Association Annual Meeting held February 25 to March 2, 2018, at the Fairmont Chateau Whistler in Whistler, British Columbia.

Address for reprints: Nelson G. Rosen, MD, CCMC, Room 158, Pediatric Surgery, 269–01 76th Ave, New Hyde Park, NY, 11040; email:

© 2018 Lippincott Williams & Wilkins, Inc.