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Ong CJ, Mourad T, Weiss P, Martin R, Palaparty G, Allam E. Sternal stress fracture presenting as acute chest pain. Radiol Case Rep 2023; 18:4435-4438. [PMID: 37823050 PMCID: PMC10563007 DOI: 10.1016/j.radcr.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 10/13/2023] Open
Abstract
Sternal fractures are rare and are typically caused by major trauma such as motor vehicle collisions. However, sternal insufficiency fractures can occur with minimal to no trauma in patients with exaggerated thoracic kyphosis from multiple thoracic compression fractures, especially in the setting of osteoporosis. We describe a case of a sternal insufficiency fracture that presented as chest pain resembling a myocardial infarction. As sternal insufficiency fractures may vary in clinical presentation, this case demonstrates that radiologists should carefully evaluate the sternum, especially when risk factors are present. Furthermore, awareness and identification of these fractures can prevent unnecessary cardiac workups.
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Affiliation(s)
- Chiew-Jen Ong
- Loyola University Chicago and Loyola University Medical Center, Department of Radiology, 2160 S 1st Ave, Maywood, IL, 60153, USA
| | - Talal Mourad
- University of Illinois College of Medicine Peoria, Peoria, IL, 61605, USA
| | - Parker Weiss
- Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, IL, 60515, USA
| | - Ryan Martin
- Loyola University Chicago and Loyola University Medical Center, Department of Radiology, 2160 S 1st Ave, Maywood, IL, 60153, USA
| | - Grace Palaparty
- Loyola University Chicago and Loyola University Medical Center, Department of Radiology, 2160 S 1st Ave, Maywood, IL, 60153, USA
| | - Emad Allam
- Loyola University Chicago and Loyola University Medical Center, Department of Radiology, 2160 S 1st Ave, Maywood, IL, 60153, USA
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Munakata H, Murakami Y, Mabuni K, Tsuchiya H, Shinzato M, Umemura T, Kugai T. Successful surgical treatment of traumatic sternal fracture with extensive mediastinal abscess and concomitant mitral valve endocarditis: a case report. J Cardiothorac Surg 2016; 11:134. [PMID: 27528381 PMCID: PMC4986367 DOI: 10.1186/s13019-016-0507-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/12/2016] [Indexed: 11/13/2022] Open
Abstract
Background A traumatic sternal fracture with extensive mediastinal abscess and concomitant native valve endocarditis is an extremely rare but catastrophic situation. Case presentation For 2 weeks, the co-infected patient was treated with aggressive debridement for the mediastinitis, change of vacuum-assisted closure therapy dressings, vegetectomy and valve repair through lower partial sternotomy, and delayed primary wound closure. Conclusions To the best of our knowledge, this successful staged strategy has not been previously reported. We believe that our quick decision about repeated surgical interventions and preservation of the manubrium led to a favorable result.
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Affiliation(s)
- Hiroshi Munakata
- Department of Cardiovascular Surgery, Okinawa Prefectural Nambu Medical Center and Children's Medical Center, Haebaru, Japan.
| | - Yu Murakami
- Department of Cardiovascular Surgery, Okinawa Prefectural Nambu Medical Center and Children's Medical Center, Haebaru, Japan
| | - Katsuhito Mabuni
- Department of Cardiovascular Surgery, Okinawa Prefectural Nambu Medical Center and Children's Medical Center, Haebaru, Japan
| | - Hiroyuki Tsuchiya
- Department of Emergency and Critical Care Medicine, Okinawa Prefectural Nambu Medical Center and Children's Medical Center, Haebaru, Japan
| | - Moriaki Shinzato
- Department of Emergency and Critical Care Medicine, Okinawa Prefectural Nambu Medical Center and Children's Medical Center, Haebaru, Japan
| | - Takehiro Umemura
- Department of Emergency and Critical Care Medicine, Okinawa Prefectural Nambu Medical Center and Children's Medical Center, Haebaru, Japan
| | - Tadao Kugai
- Department of Cardiovascular Surgery, Okinawa Prefectural Nambu Medical Center and Children's Medical Center, Haebaru, Japan
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Khoriati AA, Rajakulasingam R, Shah R. Sternal fractures and their management. J Emerg Trauma Shock 2013; 6:113-6. [PMID: 23723620 PMCID: PMC3665058 DOI: 10.4103/0974-2700.110763] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 08/07/2012] [Indexed: 11/13/2022] Open
Abstract
Sternal fractures are predominantly associated with deceleration injuries and blunt anterior chest trauma. Sternal trauma must be carefully evaluated by monitoring of vital parameters and it is of paramount importance that concomitant injuries are excluded. Nevertheless, routine admission of patients with isolated sternal fractures for observation is still common in today's practice, which is often unnecessary. This article aims to describe the prognosis, the recommended assessment and management of patients with sternal fractures, to help clinicians make an evidence-based judgment regarding the need for hospitalization.
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Affiliation(s)
- Al-Achraf Khoriati
- Department of Trauma and Orthopaedics, Lister Hospital, Stevenage SG1 4AB, Hertfordshire, England
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4
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Acute cyst rupture, hemorrhage and septic shock after a shockwave lithotripsy in a patient with autosomal dominant polycystic kidney disease. Urolithiasis 2013; 41:267-9. [DOI: 10.1007/s00240-013-0550-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 02/23/2013] [Indexed: 10/27/2022]
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Labianca L, Montanaro A, Turturro F, Calderaro C, Ferretti A. Osteomyelitis caused by Pantoea agglomerans in a closed fracture in a child. Orthopedics 2013; 36:e252-6. [PMID: 23383681 DOI: 10.3928/01477447-20130122-32] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Development of osteomyelitis in a closed fracture is rare. Although it has been reported that trivial trauma may be associated with the subsequent development of acute osteomyelitis, no evidence has been found that fractures are involved in the etiology of osteomyelitis. Only 25 cases (11 in adolescents) of osteomyelitis after closed fracture have been reported in literature. The authors report a case of osteomyelitis in an 8-year-old girl after a forearm fracture involving the diaphysis of the radius and ulna. Radiographic examinations were performed 5, 14, and 30 days after trauma. At last examination, the forearm appeared swollen and red. Blood culture and radiographs confirmed the clinical suspicion of osteomyelitis. The cultures grew Pantoea agglomerans, a saprophytic gram-negative bacterium commonly isolated from plants, flowers, seeds, water, and soil and sensitive to all of the most common antibiotics. After the arm was immobilized, high doses of intravenous antibiotics were administered for 4 weeks, and oral antibiotics were prescribed for an additional 4 weeks. The patient responded well to treatment. Twelve months after the initial injury, the patient regained full elbow and wrist flexion-extension range of motion. Based on their experience and a review of the literature, the authors suggest that bone infection be considered for patients with closed fractures complicated by excessive or prolonged pain and swelling with evident signs of inflammation where no other obvious infection is apparent. Moreover, in children, bacterial infection may cause osteomyelitis more frequently than in adults, but no evidence exists that a closed fracture increases the incidence of osteomyelitis in children with a systemic infection.
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Affiliation(s)
- Luca Labianca
- Orthopaedic Unit, S Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Young Ann J, Kwon JC, Eun Song J, Hyung Kim M, Hyun Oh D, Park Y, Ah Kim Y, Kang DY. Sternal osteomyelitis with a mediastinal abscess caused by Gemella morbillorum following blunt force trauma. Intern Med 2013; 52:511-4. [PMID: 23411712 DOI: 10.2169/internalmedicine.52.8958] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Infections caused by Gemella morbillorum are uncommon. This organism is primarily associated with endocarditis and bacteremia and rarely with spondylodiscitis, arthritis, hepatic abscesses and meningitis. Sternal osteomyelitis caused by G. morbillorum has not yet been reported. We herein present a case of sternal osteomyelitis with a mediastinal abscess caused by G. morbillorum that occurred in a 74-year-old diabetic patient following blunt force trauma to the anterior chest wall. The patient was treated successfully with surgical excision and prolonged antibiotic treatment. Early recognition and timely intervention are important for managing life-threatening osteomyelitis of the sternum.
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Affiliation(s)
- Jin Young Ann
- Department of Internal Medicine, Yonsei University College of Medicine, Korea
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Sternal Osteomyelitis and Abscess Caused by Elbowing during a Basketball Game. Case Rep Med 2012; 2012:298187. [PMID: 22811717 PMCID: PMC3395161 DOI: 10.1155/2012/298187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 06/19/2012] [Indexed: 11/23/2022] Open
Abstract
A 15-year-old boy was referred to our hospital for further investigation and treatment of sternal osteomyelitis due to blunt chest trauma, more specifically elbowing during a basketball game 19 days earlier. On an initial presentation, his chest was markedly swollen and chest computed tomography demonstrated a sternal fracture and massive fluid collection in the chest wall. Since his general condition remained fairly good, we initially selected minimal drainage concomitant with antibiotics; if it was unsuccessful, we planned to switch to a more radical debridement procedure. The patient recovered without further invasive intervention and was discharged on postoperative day 26. There is no sign of recurrence six months after operation. This case report indicates that minimal drainage would be a good option for treatment in a phased strategy.
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Font-Vizcarra L, Zumbado A, García S, Bosch J, Mensa J, Soriano A. Relationship between haematoma in femoral neck fractures contamination and early postoperative prosthetic joint infection. Injury 2011; 42:200-3. [PMID: 20951990 DOI: 10.1016/j.injury.2010.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 08/24/2010] [Accepted: 09/06/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Prosthetic joint infection (PJI) after femoral neck fracture is associated with a higher mortality, morbidity and economic costs. Although is well known that the presence of a post surgical haematoma is associated with infection, in our knowledge there are no articles evaluating the contamination of the femoral neck fracture haematoma and the possible relationship with early postoperative PJI. The aim of our study was to evaluate the prevalence of positive cultures from haematoma in patients with femoral neck fracture and the relationship with early PJI. METHODS A prospective observational study was performed. All patients who underwent hiphemiarthroplasty for a femoral neck fracture from April'08 to February'09 were included. Three samples were taken just after the arthrotomy, a tissue sample, a swab of haematoma and blood of haematoma inoculated into blood culture flasks. Patients received the standard prophylaxis. RESULTS A total of 109 patients were treated during this period in our center, 16 were excluded for mistakes during taking samples or for receiving extra antibiotic treatment after or before the surgery of the fracture. In 29 patients (31.2%) one or more intraoperative cultures were positive. Four patients developed an early PJI caused by Gram-negative bacilli (GNB) in all cases. The early PJI rate in the group of patients with negative intraopertive cultures was 3.1% while in the group with one or more positive cultures was 6.9% (p = 0.3). In 3 cases the haematoma was contaminated with a GNB. The PJI rate inpatients with intraoperative cultures positive for a GNB was 66.6% (2/3) while in the group of patients without a GNB the infection rate was 2.2% (2/89, p = 0.004, Fisher exact-test). Furthermore in these two patients the microorganism that caused the PJI was the same that had been isolated from the haematoma. CONCLUSION The haematoma in femoral neck fractures was contaminated in 31.2% of cases before surgery. The contamination of the haematoma with a GNB was associated with a higher risk of early postoperative PJI.
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Affiliation(s)
- Lluís Font-Vizcarra
- Department of Orthopaedics and Trauma Surgery of Hospital Clínic of Barcelona, University of Barcelona, C/Villarroel 170, Barcelona 08036, Spain.
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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.
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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
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Freixinet Gilart J, Solé Violán J, Rodríguez de Castro F. Abscesos múltiples de la pared torácica como complicación de un traumatismo torácico cerrado. Arch Bronconeumol 2007. [DOI: 10.1157/13110887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Randell PA, Somers L. Case of the month: "bugs are eating my soul"--sternal abscess, osteomyelitis, and mediastinitis complicating a closed sternal fracture. Emerg Med J 2007; 23:736-7. [PMID: 16921099 PMCID: PMC2564229 DOI: 10.1136/emj.2006.038000] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Wound complications of closed sternal fracture are rare, but may have serious consequences if not effectively managed. We report a case of a patient who presented to the emergency department with a sternal abscess, osteomyelitis, and mediastinitis complicating a closed sternal fracture. It is hypothesised that in our patient bacteraemia post intravenous drug use resulted in seeding of the haematoma with Staphylococcus aureus. Early diagnosis and a multidisciplinary team effort were important in ensuring a favourable outcome.
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Wedde TB, Quinlan JF, Khan A, Khan HJ, Cunningham FO, McGrath JP. Fractures of the sternum: the influence of non-invasive cardiac monitoring on management. Arch Orthop Trauma Surg 2007; 127:121-3. [PMID: 17021759 DOI: 10.1007/s00402-006-0230-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Indexed: 02/09/2023]
Abstract
Management of sternal fractures often involves a protracted hospital stay. This is often based on serial electrocardiography (ECG) and cardiac enzyme measurement (AST, CK, LDH). This retrospective study examined all cases of sternal fracture presenting to our institution between October 1998 and February 2003. Seventy-two cases were identified, 52 of which had isolated sternal fractures. Of these, 11 (21%) patients had an elevation in all cardiac enzymes. Twenty-three (44%) had an increase in some but not all. A single patient with ECG changes had no elevation in cardiac enzymes. Those patients with elevated cardiac enzymes had a significantly longer stay of 5.5 days compared with 3.7 days (P < 0.05). No adverse outcome was recorded in either group. We conclude that ECG and estimation of cardiac enzymes in these patients are of limited benefit and, when abnormal, appear to be associated with a significantly protracted and probably unnecessary hospitalisation.
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Affiliation(s)
- T B Wedde
- Department of General Surgery, Our Lady's Hospital, Navan, Co. Meath, Republic of Ireland
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Abstract
We describe a case in which an elderly woman sustained a manubrial fracture after a fall from standing. The patient did not sustain further complications from her injury and was managed medically. The radiographic appearance and clinical implications of this event are discussed.
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Aschwanden E, Bodenmann P, Schlueter L, Fivat-Arbane M, Hurni M, Qanadli SD, Jaussi A. Precordial abscess inducing chest pain 20 years after surgical repair of a pentalogy of fallot. Echocardiography 2004; 21:555-8. [PMID: 15298694 DOI: 10.1111/j.0742-2822.2004.03127.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 25-year-old male asylum-seeker presented with chest pain, exertional dyspnea, and orthopnea 20 years after the surgical repair of a pentalogy of Fallot. An extracardiac mass compressing the right ventricle was subsequently detected and surgical decompression was performed to relieve the resulting right intraventricular hypertension. At operation, the mass proved to be a coagulase-negative, staphylococcal abscess. In addition, the removal of the mass unmasked a previously nonrecognized pulmonary outflow stenosis that required balloon dilatation and beta-blocker therapy. While infections are known to occur after sternotomy, the formation of an abscess in the anterior mediastinum several years after the intervention appears to be exceptional; this diagnosis came to mind only after the more common complications had been considered, e.g., pseudoaneurysm or pericardial hematoma. To our knowledge, this is the first report of an abscess in the anterior mediastinum that had probably formed over many years following a sternotomy, compressed the right ventricle and masked a pulmonary stenosis.
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Affiliation(s)
- Riyad Karmy-Jones
- Harborview Medical Center, University of Washington, Seattle, Washington, USA
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