1
|
Aamir J, Alade B, Caldwell R, Chapman J, Shah S, Karthikappallil D, Williams L, Mason L. Sternal fractures and thoracic injury: an analysis of 288 sternal fractures attending a major trauma centre. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023:10.1007/s00590-023-03479-0. [PMID: 36735092 PMCID: PMC10368550 DOI: 10.1007/s00590-023-03479-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Sternal fractures (SF) are uncommon injuries usually associated with a significant mechanism of injury. Concomitant injury is likely, and a risk of mortality is substantial. AIM Our aim in this study was to identify the risk factors for mortality in patients who had sustained sternal fractures. METHODS We conducted a single centre retrospective review of the trust's Trauma Audit and Research Network Database, from May 2014 to July 2021. Our inclusion criteria were any patients who had sustained a sternal fracture. The regions of injury were defined using the Abbreviated Injury Score. Pearson Chi-Squared, Fisher Exact tests and multivariate regression analyses were performed using IBM SPSS. RESULTS A total of 249 patients were identified to have sustained a SF. There were 19 patients (7.63%) who had died. The most common concomitant injuries with SF were Rib fractures (56%), Lung Contusions (31.15%) and Haemothorax (21.88%). There was a significant increase in age (59.93 vs 70.06, p = .037) and admission troponin (36.34 vs. 100.50, p = .003) in those who died. There was a significantly lower GCS in those who died (10.05 vs. 14.01, p < .001). On multi regression analysis, bilateral rib injury (p = 0.037, OR 1.104) was the only nominal variable which showed significance in mortality. CONCLUSION Sternal Fractures are uncommon but serious injuries. Our review has identified that bilateral rib injuries, increase in age, low GCS, and high admission troponin in the context of SF, were associated with mortality.
Collapse
Affiliation(s)
- Junaid Aamir
- Aintree University Hospital, Liverpool, UK.,Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool, UK
| | - Bolutife Alade
- University of Liverpool, Liverpool, UK.,Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool, UK
| | - Robyn Caldwell
- Aintree University Hospital, Liverpool, UK.,Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool, UK
| | - James Chapman
- Aintree University Hospital, Liverpool, UK.,Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool, UK
| | - Sohan Shah
- Aintree University Hospital, Liverpool, UK.,Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool, UK
| | - Dileep Karthikappallil
- Aintree University Hospital, Liverpool, UK.,Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool, UK
| | - Luke Williams
- Aintree University Hospital, Liverpool, UK.,Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool, UK
| | - Lyndon Mason
- Aintree University Hospital, Liverpool, UK. .,Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool, UK.
| |
Collapse
|
2
|
Timala RB, Panthee N. Sternal Fracture Fixation with a Steel Wire: The New “Timala” Technique. JOURNAL OF TRAUMA AND INJURY 2021. [DOI: 10.20408/jti.2021.0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose Traumatic sternal fractures are rare but quite disabling injuries. Timely fixation of sternal fractures reduces pain and prevents respiratory complications. However, the fixation technique should be simple, effective, and readily available in local circumstances. Methods From January 2014 to March 2020, seven patients with sternal fracture/ dislocation underwent steel wire fixation with the new “Timala” technique. In this technique, adjacent ribs are anchored with two steel wires to form an “X” in front of the fractured segment of the sternum. Patients were followed up clinically and radiologically. Results Six of the patients were men and one was a female. Five of them had injuries due to falls and two were injured in road traffic accidents. Their age ranged from 18 years to 76 years, with a median age of 41 years. All seven patients experienced immediate recovery from pain and showed evidence of fracture healing on postoperative chest X-rays and clinical examinations. Conclusions Anchoring ribs to fix the sternum with steel wire is a safe, effective, easily available, and reproducible method to fix sternal fractures or dislocations.
Collapse
|
3
|
Marro A, Chan V, Haas B, Ditkofsky N. Blunt chest trauma: classification and management. Emerg Radiol 2019; 26:557-566. [DOI: 10.1007/s10140-019-01705-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/02/2019] [Indexed: 12/23/2022]
|
4
|
Moënne Bühlmann K, Araneda Castiglioni D, Ortega Flores X, Pérez Sánchez C, Escaffi Johnson J, Pérez Matta M, Godoy Lenz J. Clinical and radiological study of sternal fractures in paediatrics. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
5
|
Estudio clínico radiológico de las fracturas esternales en edad pediátrica. RADIOLOGIA 2019; 61:234-238. [DOI: 10.1016/j.rx.2019.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 11/21/2022]
|
6
|
Choi GC, Rahman MM, Kim H, Kim S, Jeong IS. Management of sternal dislocation with and without surgery in cats: Owner-assessed long-term follow-up of two clinical cases. J Vet Med Sci 2018; 80:1001-1006. [PMID: 29657237 PMCID: PMC6021879 DOI: 10.1292/jvms.17-0307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this paper is to report two cases of sternal dislocation (SD) in cats and the
long-term outcomes with and without surgery. In a cat with poly-traumatized SD (Case
1), mandibular, radial, and ulnar fractures were corrected first, and the SD
was allowed to heal without intervention for 14 months. However, normal healing did not
occur and sternal instability remained. Therefore, the SD was corrected surgically, and
the cat recovered fully within 4 weeks. In a cat with isolated SD (Case 2), surgery was
performed, and normal posture and gait were regained after 5 weeks. Furthermore, in both
cases, no postoperative complications were observed during follow-up. Therefore, surgical
correction of SD in cats is recommended.
Collapse
Affiliation(s)
- Gab-Chol Choi
- Animal Medical Center W, 46 World Cup-Ro, Mapo-gu, Republic of Korea
| | - Md Mahbubur Rahman
- Royal Animal Medical Center, 247, Mangu-Ro, Jungnang-gu, Seoul, Republic of Korea.,KNOTUS Co., Ltd., Research Center, 189 Donggureung-Ro, Guri-Si, Gyeonggi-Do, Republic of Korea
| | - Hwangmin Kim
- Royal Animal Medical Center, 247, Mangu-Ro, Jungnang-gu, Seoul, Republic of Korea
| | - Sehoon Kim
- Royal Animal Medical Center, 247, Mangu-Ro, Jungnang-gu, Seoul, Republic of Korea.,Korea Animal Medical Science Institute, 247, Mangu-ro, Jungnang-gu, Seoul, Republic of Korea
| | - In-Seong Jeong
- Royal Animal Medical Center, 247, Mangu-Ro, Jungnang-gu, Seoul, Republic of Korea.,KNOTUS Co., Ltd., Research Center, 189 Donggureung-Ro, Guri-Si, Gyeonggi-Do, Republic of Korea
| |
Collapse
|
7
|
Serra CI, Soler C, Moratalla V, Sifre V, Redondo JI. Surgical management of a traumatic dislocation of the sternum in an English bulldog. J Small Anim Pract 2014; 56:407-10. [PMID: 25377357 DOI: 10.1111/jsap.12289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 09/09/2014] [Accepted: 09/18/2014] [Indexed: 11/29/2022]
Abstract
A nine-year-old English bulldog presented with an acute history of dyspnoea, tachycardia and discomfort localising to the ventral thorax following a fall down the stairs that morning. After the dog was stabilised, thoracic radiographs revealed a luxation of the third and fourth sternebrae with dorsal displacement of the caudal segment. The sternum was reduced and stabilised with a contoured 12-hole 3 · 5-mm dynamic compression plate applied to the ventral surface of the sternum. The dog's initial recovery was rapid, cardiorespiratory parameters returning to normal in the first 24 hours. For 2 weeks postoperatively the dog exhibited difficulty in rising from a prone position. After this time there was a full recovery. Clinical examination at 8 months postoperatively did not reveal any abnormalities. Telephone follow-up was performed at 18 months and no complications or cardiorespiratory compromise were reported. To the authors' knowledge, this is the first reported case of a traumatic dislocation of the sternum and its management in the dog.
Collapse
Affiliation(s)
- C I Serra
- Department of Applied and Technological Sciences, Faculty of Veterinary and Experimental Sciences, Universidad Católica de Valencia, Valencia, Spain.,Department of Orthopaedics and Traumatology, SumagrupoVeterinario, Valencia, Spain
| | - C Soler
- Department of Applied and Technological Sciences, Faculty of Veterinary and Experimental Sciences, Universidad Católica de Valencia, Valencia, Spain
| | - V Moratalla
- Department of Orthopaedics and Traumatology, SumagrupoVeterinario, Valencia, Spain
| | - V Sifre
- Southern Counties Veterinary Specialists, Hampshire, BH24 3JW
| | - J I Redondo
- Facultad de Veterinaria, Universidad CEU Cardenal Herrera, Moncada, Spain
| |
Collapse
|
8
|
Karangelis D, Bouliaris K, Koufakis T, Spiliopoulos K, Desimonas N, Tsilimingas N. Management of isolated sternal fractures using a practical algorithm. J Emerg Trauma Shock 2014; 7:170-3. [PMID: 25114426 PMCID: PMC4126116 DOI: 10.4103/0974-2700.136858] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 10/03/2013] [Indexed: 11/18/2022] Open
Abstract
Background: The implementation of seat belt legislation has led to an increase in the frequency of isolated sternal fractures (ISFs) in motor vehicle crash. Aims: We reviewed retrospectively the medical records of our tertiary center in order to find out the frequency of ISFs, review our experience in their management, and define the mean length of hospitalization. Materials and Methods: From January 2008 to April 2012, 64 patients were admitted to the accident and emergency department of the University Hospital of Larissa, Greece, suffering from sternal fractures (SFs). Of these 64 patients, 45 had sustained ISF, while the remaining 19 had SF and additional injuries (intrathoracic and extrathoracic). The files of these 45 patients were further investigating as concerning the mechanism of injury, hospitalization days, morbidity, and mortality. Results: All the patients had been involved in motor vehicle crashes and most of them were wearing seat belts during the accident (91%). The hospital length of stay (LOS) was 1.85 ± 1.67. All the patients had upon admission chest radiograms, serial electrocardiographs (ECGs), echocardiograms, and cardiac enzyme levels. Two patients had abnormal ECG and abnormal cardiac enzymes which contributed in prolonged hospitalization. However, there was no incidence of cardiac complications or deaths. Conclusions: ISFs, with normal electrocardiogram, cardiac enzymes, and chest X-ray in the absence of complications, require no further investigation.
Collapse
Affiliation(s)
- Dimos Karangelis
- Department of Cardiac Surgery, Manchester Royal Infirmary, Manchester, United Kingdom ; Department of Cardiovascular and Thoracic Surgery, University Hospital of Larissa, Greece
| | - Konstantinos Bouliaris
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Larissa, Greece
| | - Theocharis Koufakis
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Larissa, Greece
| | - Kyriakos Spiliopoulos
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Larissa, Greece
| | - Nicholaos Desimonas
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Larissa, Greece
| | - Nikolaos Tsilimingas
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Larissa, Greece
| |
Collapse
|
9
|
The Association between Blunt Cardiac Injury and Isolated Sternal Fracture. Cardiol Res Pract 2014; 2014:629687. [PMID: 24653859 PMCID: PMC3933392 DOI: 10.1155/2014/629687] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 12/04/2013] [Indexed: 11/30/2022] Open
Abstract
The treatment of isolated sternal fractures (ISF) throughout the world is heterogeneous. This study aimed to identify the incidence, morbidity, and mortality associated with isolated fractures of the sternum and describe current practice for diagnosis and management of ISF and cardiac injury at a level I trauma center in the UK. A retrospective cohort study of adult patients (>16 years) with ISF presenting from 2006 to 2010 was conducted. Eighty-eight patients with ISF were identified. Most patients (88%, 77) were admitted to hospital with 66% (58) of them discharged within 48 hours. Two (2%) patients had an ER EKG with abnormality but both resolved to normal sinus rhythm within 6 hours of follow-up. Serum CEs were drawn from 55 (63%) patients with only 2 (2%) having a rise in serum troponin >0.04; however, in both of these patients troponin quickly normalized. Six (7%) patients underwent echocardiograms without significant findings. In all 88 patients with ISF, no cases of clinically significant cardiac injury were identified. Patients presenting with an isolated sternal fracture with no changes on EKG or chest X-ray do not warrant an admission to hospital and may be discharged from the ER.
Collapse
|
10
|
Dongel I, Coskun A, Ozbay S, Bayram M, Atli B. Management of thoracic trauma in emergency service: Analysis of 1139 cases. Pak J Med Sci 2013; 29:58-63. [PMID: 24353508 PMCID: PMC3809198 DOI: 10.12669/pjms.291.2704] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 12/17/2012] [Accepted: 12/17/2012] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Thoracic trauma is a common cause of significant morbidity and mortality. This study presents a series of thoracic trauma with the aim to assess epidemiologic features, distribution of pathologies, additional systemic injuries, diagnosis, management and outcome. METHODOLOGY Between January 2007 and December 2011, all patients with thorax trauma admitted to the emergency service of our hospital were retrospectively reviewed with respect to age, gender, etiological factors, distribution of pathologies, additional systemic injuries, diagnosis, treatment modalities, referral and outcome. RESULTS A total of 1139 patients with thorax trauma were included in the study. Of these, 698 (61.3%) were male and 441 (38.7%) were female, and the average age was 54.17±17.39 years. 1090 (95.7%) of the patients had blunt trauma, whereas 49 (4.3%) had penetrating trauma. Etiological factors were falls in 792 (69.5%), motor vehicle accidents in 259 (22.8%), animal related accidents in 39 (3.4%) and penetrating injuries in 49 (4.2%) patients. It was found that 229 (20%) patients had single, 101 (8.9%) had double, 5 (3%) had three or more, 10 (0.9%) had bilateral rib fractures and 19 (1.7%) had sternal fracture. Pneumothorax was diagnosed in 58 (5.1%) patients, whereas hemothorax, hemopneuomothorax and other system injuries were diagnosed in 36 (3.2%), 38(3.3%) and 292 (25.6%) respectively. In our series, thirteen patients (mortality rate 1.1%) died as result of hemorrhagic shock (n=8), respiratory distress (n=3) and severe multiple trauma (n=2). CONCLUSION Although majority of the patients with thorax trauma receive treatment as outpatients; thoracic traumas may be a life threatening condition, and should be identified and treated immediately. Mortality varies based on etiological factors, additional systemic pathologies, capabilities of the hospital especially diagnostic and treatment facilities in emergency services. We believe that a multidisciplinary approach to the patients with severe thorax trauma, and the opportunities of emergency bedside thoracotomy in emergency services will significantly reduce the morbidity and mortality.
Collapse
Affiliation(s)
- Isa Dongel
- Isa Dongel, Dept. of Thoracic Surgery, Suleyman Demirel University, Isparta, Turkey
| | - Abuzer Coskun
- Abuzer Coskun, Dept. of Emergency, Cumhuriyet University, Sivas, Turkey
| | - Sedat Ozbay
- Sedat Ozbay, Dept. of Emergency, Sivas Numune Hospital, Sivas, Turkey
| | - Mehmet Bayram
- Mehmet Bayram, Dept. of Chest Disease, Bezmialem Vakif University, Istanbul, Turkey
| | - Bahri Atli
- Bahri Atli, Dept. of Emergency, Karabuk State Hospital, Karabuk, Turkey
| |
Collapse
|
11
|
Isolated sternum fracture with no direct trauma. Am J Emerg Med 2012; 31:631.e1-3. [PMID: 23122418 DOI: 10.1016/j.ajem.2012.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 09/03/2012] [Accepted: 09/08/2012] [Indexed: 11/21/2022] Open
|
12
|
Hossain M, Ramavath A, Kulangara J, Andrew JG. Current management of isolated sternal fractures in the UK: time for evidence based practice? A cross-sectional survey and review of literature. Injury 2010; 41:495-8. [PMID: 19682680 DOI: 10.1016/j.injury.2009.07.072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 07/14/2009] [Accepted: 07/20/2009] [Indexed: 02/02/2023]
Abstract
Routine admission of patients with isolated sternal fractures for observation is still widespread in the UK. However, the evidence appears to suggest that this is unnecessary. We undertook a cross-sectional telephone survey of management of isolated sternal fractures in the UK. We contacted 85 acute admitting units over a three-month period and were able to get a response from 67 units. Most of the hospitals were district general hospitals (52) and situated in England (49). The orthopaedic department was the most common admitting department. 51 units indicated that they regularly admit isolated sternal fractures for observation. Other indications for admission included pain control (33), abnormal cardiac enzymes (28), social circumstances (23), abnormal electrocardiogram (6), and low oxygen saturation (5). Chest X-ray was performed on admission in all hospitals. 57 hospitals performed ECG and cardiac enzyme tests prior to admission and 6 hospitals carried out echocardiogram following admission on a regular basis. Patients were not followed up on discharge. 2 hospitals with on-site cardiothoracic unit followed-up patients on discharge, and 1 hospital advised GP follow-up. A review of the literature indicated that patients with isolated sternal fractures are at low risk of significant cardiac, pulmonary or mediastinal complications and do not need extensive investigations or routine admission. The current practice of management of isolated sternal fractures in the UK does not appear to conform to available evidence. In order to decide on management plans based on more rigorous evidence, there is a need for a prospective double blind randomised study of patients with isolated sternal fractures, comparing those discharged to those admitted over a longer follow-up period.
Collapse
Affiliation(s)
- M Hossain
- Department of Trauma and Orthopaedic Surgery, Ysbyty Gwynedd, UK.
| | | | | | | |
Collapse
|
13
|
Abstract
Sternal fractures are relatively common and range from simple unicortical cracks to displaced fractures associated with life threatening injuries. This paper describes the relevant anatomy, biomechanics, mechanism of injury, clinical presentation, investigation, treatment and complications and also includes associated and concomitant injuries. A management flow chart including criteria for discharge from the emergency department is presented.
Collapse
Affiliation(s)
- Rangan Raghunathan
- Selly Oak Hospital, University Hospital Birmingham NHS Trust, Selly Oak, Birmingham, West Midlands, B29 6JD, UK,
| | - Keith Porter
- Selly Oak Hospital, University Hospital Birmingham NHS Trust, Selly Oak, Birmingham, West Midlands, B29 6JD, UK
| |
Collapse
|
14
|
von Garrel T, Ince A, Junge A, Schnabel M, Bahrs C. The Sternal Fracture: Radiographic Analysis of 200 Fractures with Special Reference to Concomitant Injuries. ACTA ACUST UNITED AC 2004; 57:837-44. [PMID: 15514539 DOI: 10.1097/01.ta.0000091112.02703.d8] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The assessment of the sternal fracture and concomitant injuries is discussed. METHODS Two hundred sternal fractures were analyzed with respect to accident circumstances, fracture morphology and topography, and associated injuries. RESULTS Traffic accidents were frequent; 89.2% of them were motor vehicle crashes of restrained passengers, 76.5% of fractures were localized in the corpus sterni, and 8.5% of the injuries resulted in fractures or complete disruptions of the synchondrosis manubriosternalis. Nondisplaced or slightly displaced fractures (75.5%) occurred more frequently compared with moderately and severely displaced fractures (24.5%). In 29.5% of the patients, concomitant thoracic injuries were diagnosed. Spinal fractures were evaluated in 13%. In displaced fractures of the corpus, thoracic and cardiac injuries were observed frequently. In fractures or disruptions of the synchondrosis manubriosternalis, concurrence of spinal fractures clearly increased. CONCLUSION The observation of fracture morphology and topography, with reference to displacement, gives important information about the existence of serious concomitant injuries and can determine further diagnostic and therapeutic options in sternal fractures.
Collapse
Affiliation(s)
- Thomas von Garrel
- Klinik für Unfall, Wiederherstellungs-, and Handchirurgie, Phillipps-Universität Marburg, Marburg, Germany.
| | | | | | | | | |
Collapse
|
15
|
Potaris K, Gakidis J, Mihos P, Voutsinas V, Deligeorgis A, Petsinis V. Management of sternal fractures: 239 cases. Asian Cardiovasc Thorac Ann 2002; 10:145-9. [PMID: 12079939 DOI: 10.1177/021849230201000212] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A review of the management of 239 patients with sternal fractures in a busy trauma center between October 1989 and May 2000 was undertaken to determine the incidence, significance, morbidity, and mortality of this injury. There were 140 men and 99 women with a mean age of 50.3 years (range, 15 to 93 years). Sternal fractures accounted for 8% of admissions for thoracic trauma. The causes were motor vehicle collisions in 215 patients (90%) and falls or direct blows in 24 (10%). Only 64 of 204 car accident patients (31%), 28 men and 36 women, were restrained by seat belts. Complications developed in 13 patients (5.4%). Mortality rate was 0.8%. Mean length of stay in the ward was 6.4 days (range, 1 to 32 days). Four patients (1.7%) underwent surgery. The results show that isolated sternal fractures have low associated morbidity and mortality. Admission is justified for the management of pain and treatment of cardiac complications and concomitant injuries.
Collapse
Affiliation(s)
- Konstantinos Potaris
- Department of Thoracic Surgery, District General Hospital of Attica KAT, Kifissia, Greece.
| | | | | | | | | | | |
Collapse
|
16
|
Spontaneous insufficiency fractures of long bones: a prospective epidemiological survey in nursing home subjects. Arch Gerontol Geriatr 2000; 31:207-214. [PMID: 11154775 DOI: 10.1016/s0167-4943(00)00081-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 30-month prospective observational cohort study was led to assess the prevalence of and describe the clinical features of spontaneous long bone insufficiency fractures (LBIF) in the 'oldest old' patients of long-term nursing homes (LTNH). The study was conducted in 30 LTNH in northeast France, which represented 3052 beds. Subjects aged 65 and more showing LBIF were included in the present study. Clinical data and outcome were collected. Fifty-five LBIF were found. The prevalence of LBIF calculated on the basis of the number of patients consecutively admitted in LTNH was 1%. The mean age of the subjects was 85+/-7 years. The LBIF sites were as follows (1) hip fractures in 15 subjects (27%); (2) femoral shaft fractures in 13 subjects (24%); (3) tibia and/or fibula fractures in 14 subjects (25%); (4) humerus fractures in 11 subjects (20%); (5) cubitus in 2 subjects. The global mortality at 2 months was 24%. The poorest outcome was observed in the group with femoral shaft fracture who showed mortality of 54% at 2 months. The dramatic repercussions in outcome and quality of life in bedridden patients show that the detection of LBIF should not be neglected in nursing homes. There is no consensus for a preventive pharmacological treatment in these patients. Educational programs for 'proper handling' by the nursing staff are highly recommended.
Collapse
|
17
|
Martin-Hunyadi C, Kaltenbach G, Heitz D, Demuynck-Roegel C, Berthel M, Kuntzmann F. [Clinical and prognostic aspects of spontaneous fractures in long term care units: a thirty month prospective study. Eastern Gerontology Society]. Rev Med Interne 2000; 21:747-55. [PMID: 11039170 DOI: 10.1016/s0248-8663(00)00220-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Spontaneous fractures (stress and bone insufficiency fractures) are well described in young healthy patients; however, few studies were conducted in the elderly. METHODS A 30-month prospective clinical and epidemiological survey including elderly patients from long-term nursing homes (LTNH) of the Société de Gérontologie de l'Est (70 centers; 11,495 elderly patients in total) was conducted. RESULTS Sixty-seven spontaneous fractures were encountered in 30 LTNH (3,052 elderly patients) (five stress fractures of the foot, 62 bone insufficiency fractures). The mean age of bedridden patients was 85 +/- 7 years. The prevalence of spontaneous fractures (calculated from the number of patients admitted consecutively in LTNHs) was 0.34% in the whole population (11,495 beds). When the calculation was based on LTNH reports of spontaneous fractures (3,052 elderly patients), the prevalence reached 1.3%. Fractures of long bones were common in elderly patients and included 15 fractures of the femoral neck, 14 fractures of either the tibia or fibula, 13 fractures of the femoral shaft, and 11 fractures of the humerus. Fractures of the femoral shaft were associated with the highest mortality: seven out of 13 patients died versus two out of 15 patients with regard to fractures of the femoral neck (P < 0.05). CONCLUSION Bone insufficiency fractures have not the same course in young healthy patients as those in elderly nursing home patients: they more often concern long bones and their prognosis is worse. Means of prevention still have to be defined.
Collapse
Affiliation(s)
- C Martin-Hunyadi
- Service de médecine interne-gériatrie, hôpital de la Robertsau, CHUR, Strasbourg, France
| | | | | | | | | | | |
Collapse
|
18
|
Crestanello JA, Samuels LE, Kaufman MS, Thomas MP, Talucci R. Sternal fracture with mediastinal hematoma: delayed cardiopulmonary sequelae. THE JOURNAL OF TRAUMA 1999; 47:161-4. [PMID: 10421206 DOI: 10.1097/00005373-199907000-00034] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- J A Crestanello
- Department of Surgery, Allegheny University Hospitals, Hahnemann Division, Philadelphia, Pennsylvania 19102-1192, USA
| | | | | | | | | |
Collapse
|
19
|
de Oliveira M, Hassan TB, Sebewufu R, Finlay D, Quinton DN. Long-term morbidity in patients suffering a sternal fracture following discharge from the A and E department. Injury 1998; 29:609-12. [PMID: 10209593 DOI: 10.1016/s0020-1383(98)00145-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the duration of symptoms and long term outcome in patients who were discharged home from the A and E department having sustained an isolated fracture of the sternum. DESIGN Postal questionnaire. OUTCOME MEASURES Patients were asked specific questions regarding advice and analgesia given on discharge, length of time off work, if appropriate, and length of time of symptoms related to the injury. RESULTS A response rate of 55% was achieved. The majority of patients had been involved in a motor vehicle accident. Chest pain was the predominant persisting symptom lasting for a mean period of 10.9 weeks. Duration of symptoms was significantly prolonged in patients over the age of 50 (p < 0.03). Although injury was more common in females this was not statistically significant (p < 0.09). Advice given regarding rehabilitation was poor and variable. CONCLUSION Patients suffering a sternal fracture have prolonged symptoms. Those being discharged home from the A and E department are at present being given variable and poor advice. A more formal approach to rehabilitation, analgesia and a letter to the general practitioner outlining prognosis will improve their standard of care.
Collapse
Affiliation(s)
- M de Oliveira
- Department of Orthopaedics, Derbyshire Royal Infirmary, Derby, U.K
| | | | | | | | | |
Collapse
|
20
|
Abstract
We have reviewed 162 consecutive cases of sternal fracture admitted to the Leicester Royal Infirmary over a 10 year period. There were no incidences of cardiogenic shock or arrhythmia developing in patients who had sustained an isolated sternal fracture, irrespective of the aetiology. There were three deaths, three ITU admissions and one arrhythmia, all occurring in patients with severe thoracic injuries, or other associated injury. Our series confirms the observations of other authors, that patients with isolated sternal fractures, especially those sustained by car occupants wearing seatbelts, do not develop myocardial pump failure or arrhythmias as a late or occult phenomenon and can often be discharged home if there is no clinical evidence of cardiac failure and a 12-lead ECG is normal.
Collapse
Affiliation(s)
- G J Peek
- Department of Cardiothoracic Surgery, Glenfield Hospital, Leicester, UK
| | | |
Collapse
|