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Proctor DW, Goodall R, Borsky K, Salciccioli JD, Marshall DC, Shalhoub J. Trends in the incidence of rib and sternal fractures: A nationwide study of the global burden of disease database, 1990-2019. Injury 2024; 55:111404. [PMID: 38354687 DOI: 10.1016/j.injury.2024.111404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Fractures of the ribs and sternum are associated with significant morbidity and mortality. Characterization of the injury burden across England is necessary to inform and evaluate developments in trauma care and infrastructure, however is yet to be comprehensively undertaken. Therefore, the aim of this study was to describe trends in the incidence of sternal and rib fractures across England between 1990 and 2019. MATERIALS AND METHODS Age-standardised incidence rates (ASIRs) for rib and sternal fractures in males and females were extracted from the 2019 Global Burden of Disease (GBD) study by all causes, falls and road traffic collisions for 9 sub-regions of England. Temporal trends within the study period were analysed using Joinpoint regression analysis. RESULTS The overall ASIRs in England in 2019 were 30.34/100,000 and 46.02/100,000 for females and males, respectively. Between 1990 and 2019, the estimated overall percentage change across England was +0.20 % among females and -7.05 % among males. A statistically significant increase in ASIR was observed in all 9 sub-regions of England among females from 2014-2019 (p<0.001). Among males, a statistically significant increase in ASIR was observed in 7 of the 9 regions from 2014-2019 (p<0.001) and in the remaining 2 regions from 2015-2019 (p<0.001). DISCUSSION Increasing ASIRs of rib and sternal fractures were observed among females and decreasing ASIRs among males, with overall ASIRs higher among males. Developments in trauma infrastructure and associated variations in diagnostic and management strategies over the observation period likely contribute to changes in the national injury burden. The findings are suggestive of the importance of ongoing financial investment in trauma infrastructure and of clear clinical guidelines to manage an increasing national injury burden.
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Affiliation(s)
| | | | - Kim Borsky
- Department of Plastic Surgery, Salisbury Hospital, Salisbury, UK
| | - Justin D Salciccioli
- Imperial College London, London, UK; Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
| | | | - Joseph Shalhoub
- Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
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2
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Liebsch C, Spering C, Wilke HJ. [Biomechanics of thoracic wall instability]. Unfallchirurgie (Heidelb) 2024; 127:180-187. [PMID: 37964040 DOI: 10.1007/s00113-023-01389-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 11/16/2023]
Abstract
Traumatic injuries of the thorax can entail thoracic wall instability (flail chest), which can affect both the shape of the thorax and the mechanics of respiration; however, so far little is known about the biomechanics of the unstable thoracic wall and the optimal surgical fixation. This review article summarizes the current state of research regarding experimental models and previous findings. The thoracic wall is primarily burdened by complex muscle and compression forces during respiration and the mechanical coupling to spinal movement. Previous experimental models focused on the burden caused by respiration, but are mostly not validated, barely established, and severely limited with respect to the simulation of physiologically occurring forces. Nevertheless, previous results suggested that osteosynthesis of an unstable thoracic wall is essential from a biomechanical point of view to restore the native respiratory mechanics, thoracic shape and spinal stability. Moreover, in vitro studies also showed better stabilizing properties of plate osteosynthesis compared to intramedullary splints, wires or screws. The optimum number and selection of ribs to be fixated for the different types of thoracic wall instability is still unknown from a biomechanical perspective. Future biomechanical investigations should simulate respiratory and spinal movement by means of validated models.
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Affiliation(s)
- Christian Liebsch
- Institut für Unfallchirurgische Forschung und Biomechanik, Zentrum für Traumaforschung Ulm, Universitätsklinikum Ulm, Helmholtzstr. 14, 89081, Ulm, Deutschland.
| | - Christopher Spering
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Hans-Joachim Wilke
- Institut für Unfallchirurgische Forschung und Biomechanik, Zentrum für Traumaforschung Ulm, Universitätsklinikum Ulm, Helmholtzstr. 14, 89081, Ulm, Deutschland
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3
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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. Eur J Orthop Surg Traumatol 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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Kwater A, Sen S, de Haan J, Ge M, Kim A, Hernandez N. Ultrasound-guided percutaneous cryoneurolysis for management of acute sternal fracture pain. Trauma Case Rep 2023; 43:100751. [PMID: 36636466 PMCID: PMC9829744 DOI: 10.1016/j.tcr.2022.100751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/05/2023] Open
Abstract
Background Establishing adequate analgesia for rib and sternal fractures remains a challenge due to the prolonged nature of the associated pain. Historically, cryoneurolysis has demonstrated beneficial in treating chronic pain, and the recent development of hand-held devices has allowed its functionality to expand into the management of acute pain. Case We present a polytrauma patient with sternal and multiple rib fractures that underwent ultrasound-guided intercostal cryoneurolysis at bedside, resulting in significant analgesia lasting several weeks and improving mobilization. This is the first report of the utilization of cryoneurolysis to treat acute sternal fracture pain. Conclusion The most common sternal fracture pattern is transverse which only requires treatment of four intercostal nerves, making cryoneurolysis feasible in trauma centers. This portable, minimally invasive, and low risk technique has the added benefits of reducing opioid requirements, decreasing length of hospital stay, and improving mobility in polytrauma patients.
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Affiliation(s)
- A.P. Kwater
- University of Texas MD Anderson Cancer Center, Department of Anesthesiology & Perioperative Medicine, 1400 Holcombe Blvd., Unit 409, Houston, TX 77030, United States of America
| | - S. Sen
- McGovern School of Medicine at UTHealth, Department of Anesthesiology & Perioperative Medicine, 6431 Fannin Street, MSB 5.020, Houston, TX 77030, United States of America
| | - J.B. de Haan
- McGovern School of Medicine at UTHealth, Department of Anesthesiology & Perioperative Medicine, 6431 Fannin Street, MSB 5.020, Houston, TX 77030, United States of America
| | - M.A. Ge
- McGovern School of Medicine at UTHealth, Department of Anesthesiology & Perioperative Medicine, 6431 Fannin Street, MSB 5.020, Houston, TX 77030, United States of America
| | - A.M. Kim
- McGovern School of Medicine at UTHealth, 6431 Fannin Street, Houston, TX 77030, United States of America,Corresponding author.
| | - N. Hernandez
- McGovern School of Medicine at UTHealth, 6431 Fannin Street, MSB 5.020, Houston, TX 77030, United States of America
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Nathwani JN, Baucom MR, Salvator A, Makley AT, Tsuei BJ, Droege CA, Goodman MD, Nomellini V. Evaluating the Utility of High Sensitivity Troponin in Blunt Cardiac Injury. J Surg Res 2023; 281:104-111. [PMID: 36152398 DOI: 10.1016/j.jss.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 07/28/2022] [Accepted: 08/19/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Screening for blunt cardiac injury (BCI) includes obtaining a serum troponin level and an electrocardiogram for patients diagnosed with a sternal fracture. Our institution has transitioned to the use of a high sensitivity troponin I (hsTnI). The aim of this study was to determine whether hsTnI is comparable to troponin I (TnI) in identifying clinically significant BCI. MATERIALS AND METHODS Trauma patients presenting to a level I trauma center over a 24-mo period with the diagnosis of sternal fracture were screened for BCI. Any initial TnI more than 0.04 ng/mL or hsTnI more than 18 ng/L was considered positive for potential BCI. Clinically significant BCI was defined as a new-bundle branch block, ST wave change, echocardiogram change, or need for cardiac catheterization. RESULTS Two hundred sixty five patients with a sternal fracture were identified, 161 underwent screening with TnI and 104 with hsTnI. For TnI, the sensitivity and specificity for detection of clinically significant BCI was 0.80 and 0.79, respectively. For hsTnI, the sensitivity and specificity for detection of clinically significant BCI was 0.71 and 0.69, respectively. A multivariate analysis demonstrated the odds ratio for significant BCI with a positive TnI was 14.4 (95% confidence interval, 3.9-55.8, P < 0.0001) versus an odds ratio of 5.48 (95% confidence interval 1.9-15.7, P = 0.002) in the hsTnI group. CONCLUSIONS The sensitivity of hsTnI is comparable to TnI for detection of significant BCI. Additional investigation is needed to determine the necessity and interval for repeat testing and the need for additional diagnostic testing.
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Affiliation(s)
- Jay N Nathwani
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
| | - Matthew R Baucom
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Ann Salvator
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Amy T Makley
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Betty J Tsuei
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
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Sairanen JJ, Arponen O. Isolated sternal fracture after low-energy trauma in a geriatric patient: a case report. Int J Emerg Med 2022; 15:34. [PMID: 35906542 PMCID: PMC9338590 DOI: 10.1186/s12245-022-00437-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Falls are a common cause of emergency department (ED) visits for the older population. If osteoporosis is present, even falls from standing height can lead to unusual fractures normally associated with high-energy trauma. In this report, we analyze a rare case of an isolated sternal fracture with an unusual mechanism of injury. Our discussion aims to improve care for older adults with fall-related fractures. Case presentation An 86-year-old female presented in the ED of our hospital with a complaint of chest pain. She recalled a fall at home the previous day and described how her fist was impacted between the floor and her chest. A physical examination revealed local tenderness in the mid-chest. A lateral chest x-ray indicated a sternal fracture, and a chest computed tomography scan ruled out concomitant injuries. There were no acute changes on her electrocardiogram (ECG). Conservative outpatient treatment was started, and referrals were made with a recommendation to initiate fall prevention measures and osteoporosis screening in primary health care. Conclusions Geriatric patients can present in the ED with a rare sternal fracture even after only a minor chest trauma. Appropriate imaging and an ECG are warranted to exclude life-threatening additional injuries. An in-depth physical examination and an understanding of the exact mechanism of injury are important to avoid missing fractures in unexpected locations. Modern ED physicians could have an important role in the secondary prevention of fall-related fractures for geriatric patients.
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Affiliation(s)
- Joni J Sairanen
- Emergency Department, Tampere University Hospital, Tampere, Finland
| | - Otso Arponen
- Department of Radiology, Tampere University Hospital, Tampere, Finland. .,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
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Minervini F, van Veelen NM, Van de Wall BJM, Beeres FJP, Michelitsch C; Sternal Fracture Classification Observer Group. Validation of the modified AO sternum classification system. Eur J Orthop Surg Traumatol 2022. [PMID: 35704065 DOI: 10.1007/s00590-022-03302-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The Arbeitsgemeinschaft für Osteosynthesefragen (AO) foundation along with the Orthopaedic. Trauma Association (OTA) introduced a new classification for sternal fractures in 2018 aiming to provide greater uniformity and clinical utility for the surgical community. A previous validation study identified some critical issues such as the differentiation between type A and B fractures and localization of the fracture either in the manubrium or in the body. Due to the moderate agreement in inter- and intra-observer variability, some modifications were proposed in order to improve the performance of the classification. The aim of this study was to re-assess the inter- and intra-observer variability after adding modifications to the classification. Our hypothesis was that a significative improvement of inter- and intra-observer variability could be achieved. MATERIAL AND METHODS Twenty computed tomography (CT) scans of patients with sternal fractures were analyzed by six. Junior and six senior surgeons independently. Two assessments were performed with an interval of 6 weeks. The kappa (K) value was calculated in order to assess inter- and intra-observer variability. RESULTS The overall mean kappa value for inter-observer variability improved from 0.364 to 0.468 (p < 0.001). Inter-observer variability mean for location was 0.573 (SD 0.221) and for type was 0.441 (SD: 0.181). Intra-observer variability showed a mean of 0.703 (SD: 0.153) with a statistic significant improvement when compared to the previous study (mean 0.414, SD: 0.256, p < 0.001). CONCLUSIONS By modifying the AO/OTA classification of sternal fractures, the inter- and intra-observer variability improved and now shows moderate to substantial agreement.
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Breitenbach M, Phan A, Botros M, Paul D, Molinari R, Menga E, Mesfin A. The fourth column of the spine: Prevalence of sternal fractures and concurrent thoracic spinal fractures. Injury 2022; 53:1062-1067. [PMID: 34980462 DOI: 10.1016/j.injury.2021.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 12/23/2021] [Indexed: 02/02/2023]
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE This study aimed to identify the prevalence of concomitant thoracic spinal and sternal fractures and factors associated with concomitant fractures. SUMMARY OF BACKGROUND DATA The sternum has been implicated in stability of the upper thoracic spine, and both bony structures are included in the stable upper thoracic cage. High force trauma to the thorax can cause multiple fractures to different upper thoracic cage components. METHODS This is a retrospective analysis of electronic medical record data of patients treated at a Level 1 Trauma Center who underwent surgery for thoracic spinal fracture between 2008-2020. We recorded presence of concomitant sternal fracture, injury characteristics, hospital course data, and demographic information. RESULTS 107 patients with thoracic spinal fractures had a sternal fracture prevalence of 18.7%. The average age was 53.2 [15-90]. 72 (67.3%) were male and 35 (32.7%) were female, 92 (85.9%) were White, 10 (9.3%) were African American, 3 (2.8%) were Hispanic, and 2 (1.9%) were Asian. The average age of patients with sternal fractures was 48.7 years, compared to those without sternal fractures, 54.3 years (P = 0.251). Patients with T1-T7 fractures [14 of 48 (29.2%)] had a significantly higher rate of sternal fractures compared to patients with T8-T12 fractures [6 of 59 (10.2%)] (P = 0.012). Patients with additional rib (P < 0.001), scapula (P = 0.01), clavicle fractures (P = 0.01), and those with multiple other thoracic fractures (P = 0.01) had significantly higher rates of sternal fractures compared to patients without these. Patients with concomitant sternal fractures [10 of 20 (50.0%)] had a significantly higher rate of respiratory complication during their hospital course than patients without concomitant sternal fracture [40 of 87 (46.0%)] (P < 0.001). Sex, age, mechanism of injury, fracture morphology, estimated blood loss during surgery, intraoperative complications, post-surgical intubation status, and post-surgical intubation duration were not associated with sternal fractures. CONCLUSIONS The prevalence of concomitant thoracic spinal fracture and sternal fracture in our series is 18.7%. T1-T7 fractures and presence of rib, scapula, and clavicle fractures were significantly associated with the presence of sternal fractures. Presence of concomitant sternal fracture was significantly associated with respiratory complication during hospital course.
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Affiliation(s)
- Mitchell Breitenbach
- Department of Orthopaedic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Amy Phan
- Department of Orthopaedic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Mina Botros
- Department of Orthopaedic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - David Paul
- Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Robert Molinari
- Department of Orthopaedic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Emmanuel Menga
- Department of Orthopaedic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Addisu Mesfin
- Department of Orthopaedic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
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Fokin AA, Wycech Knight J, Abid AT, Yoshinaga K, Alayon AL, Grady R, Weisz RD, Puente I. Sternal fractures in blunt trauma patients. Eur J Trauma Emerg Surg 2022; 48:2987-2998. [PMID: 35022803 DOI: 10.1007/s00068-021-01871-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/28/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Sternal fractures (SF) are commonly associated with other injuries and their incidence is on the rise. The aim was to evaluate injury characteristics and outcomes in patients with all types of SF after blunt trauma. METHODS Retrospective analysis of 380 SF patients from two Level 1 trauma centers was performed. Patients were compared in various combinations: geriatric versus non-geriatric, isolated sternal fractures (ISF) versus combined sternal fractures (CSF), sternal body versus manubrium, displaced versus non-displaced, and with retrosternal hematoma versus without. Analyzed variables included: age, gender, race, comorbidities, mechanism of injury (MOI), injury severity score (ISS), Glasgow Coma Score (GCS), type and location of SF, concomitant fractures of ribs, vertebrae, clavicles and scapulae, co-injuries, rates of surgical stabilization, mechanical ventilation requirements, intensive care unit (ICU) admission, ICU length of stay (ICULOS), hospital LOS (HLOS), complications, and mortality. RESULTS ISF constituted 17.9% of all patients with no mortality. CSF patients constituted 82.1%, had more ICU admissions, longer ICULOS/HLOS and 9.3% mortality (all p < 0.001). Geriatric SF had more concomitant rib fractures and 12.9% mortality. Concomitant fractures of ribs were present in 56.7% and had higher ICU admissions, ICULOS and complications compared to SF patients with concomitant vertebrae fractures diagnosed in 38.2%. CONCLUSION SF are present in 2.1% of admissions to trauma centers. Geriatric patients account for half of SF patients and have higher mortality. Concomitant fractures of ribs are present in half and vertebrae fractures in one-third of the SF patients. CSF portend higher mortality and pulmonary co-injuries. The high incidence of concomitant rib and vertebra fractures requires additional diagnostic and treatment considerations.
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Affiliation(s)
- Alexander A Fokin
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA. .,Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA.
| | - Joanna Wycech Knight
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.,Division of Trauma and Critical Care Services, Broward Health Medical Center, 1600 S Andrews Ave, Fort Lauderdale, FL, 33316, USA
| | - Ayesha T Abid
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.,Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA
| | - Kai Yoshinaga
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.,Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA
| | - Amaris L Alayon
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.,Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA
| | - Robert Grady
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.,Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA
| | - Russell D Weisz
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA
| | - Ivan Puente
- Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.,Charles E. Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA.,Division of Trauma and Critical Care Services, Broward Health Medical Center, 1600 S Andrews Ave, Fort Lauderdale, FL, 33316, USA.,Herbert Wertheim College of Medicine, Department of Surgery, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
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11
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Nishimura H, Mochida Y, Ogino S, Fukushi K, Yamazaki H, Miyakuni Y, Kaita Y, Minamishima T, Soejima K, Yamaguchi Y. Critical anterior mediastinal hematoma without internal mammary artery injury caused by cardiopulmonary resuscitation: A case report. Trauma Case Rep 2022; 37:100587. [PMID: 35005164 PMCID: PMC8718651 DOI: 10.1016/j.tcr.2021.100587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2021] [Indexed: 11/15/2022] Open
Abstract
Background Massive anterior mediastinal hematoma due to chest compression during cardiopulmonary resuscitation is often caused by internal mammary artery injury. However, critical massive anterior mediastinal hematoma without damage to major blood vessels is extremely rare. We report a case of life-threatening anterior mediastinal hematoma without internal mammary artery injury during extracorporeal cardiopulmonary resuscitation. Case presentation A 70-year-old man was transferred to our emergency department because of ventricular fibrillation arrest. Manual chest compressions and venoarterial extracorporeal membrane oxygenation were applied in the angiography room. Acute myocardial infarction was diagnosed, and percutaneous coronary intervention with stent placement was performed. Despite the establishment of venoarterial extracorporeal membrane oxygenation flow, the hemodynamics were unstable. Computed tomography revealed a massive anterior mediastinal hematoma compressing the right heart system and causing obstructive shock. Although local incision and anterior mediastinal hematoma drainage were tried for resolving obstructive shock, the patient's anemia did not improve, and there was still continuous hemorrhaging from the drainage tube. A median thoracotomy was then performed. There was no injury of the main trunk of the internal mammary artery but only hemorrhaging from the sternal fracture site. The patient's hemodynamics and anemia improved after hemostasis and gauze packing. Re-thoracotomy for gauze removal and sternal closure was performed three days post-hospitalization. Conclusions It is important to consider hemorrhaging and unstable hemodynamics in patients who receive extracorporeal cardiopulmonary resuscitation. Therefore, a thoracotomy may take precedence over intravascular treatment for restoring hemostasis when there is no information regarding the bleeding site, such as the presence of extravasation.
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Affiliation(s)
- Hirotaka Nishimura
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Yuki Mochida
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Satoyuki Ogino
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Kei Fukushi
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2, Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Hiroyuki Yamazaki
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2, Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Yasuhiko Miyakuni
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Yasuhiko Kaita
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Toshinori Minamishima
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2, Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2, Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Yoshihiro Yamaguchi
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
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Abstract
OBJECTIVE Traumatic sternal fractures are injuries most commonly resulting from a direct blow to the anterior chest wall or forced deceleration. The purpose of this review is to define the clinical significance of these injuries, outline their initial evaluation and work up, and review current treatment strategies available and their outcomes. BACKGROUND The diagnosis of traumatic sternal fractures has seen a recent rise, largely due to the increased access to computed tomography (CT) scan. Currently, there are no published guidelines to make recommendations on operative fixation for sternal fractures. This is probably related to the lack of evidence in published literature along with patient heterogeneity. METHODS We conducted a non-systematic review of the English literature published from January 2000 to December 2020, including meta-analyses, systematic reviews, case series and case reports regarding the diagnosis, treatment, and complications of traumatic sternal fractures. We critically analyzed the available evidence to provide an overview of the treatment and clinical outcomes of traumatic sternal fractures. CONCLUSION Isolated sternal fractures are commonly benign injuries that can be managed conservatively in an outpatient setting. Polytrauma patients with sternal fractures should be carefully screened for possible associated injuries. Surgical stabilization of sternal fractures is feasible and safe, and should be considered in unstable fractures, severe displacement, symptomatic malunion or non-union.
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Affiliation(s)
| | - Ilitch Diaz-Gutierrez
- Department of Surgery, Division of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, MN, USA
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Abstract
BACKGROUND Isolated sternal fracture, a benign injury, has been increasing in the pan-scan era, although one-third of patients with sternal fracture still has trouble with concomitant injury. The differentiation of these two entities is important to optimize patient management. PURPOSE To evaluate correlation between retrosternal hematoma and concomitant injury in patients with sternal fracture and to identify predicting factors for concomitant injury in sternal fracture. MATERIAL AND METHODS A total of 139 patients (84 men; mean age = 54.9 ± 15.3 years) with traumatic sternal fracture were enrolled in this study. We reviewed medical charts and multiplanar computed tomography (CT) images to evaluate cause, location, and degree of sternal fracture, retrosternal hematoma, and concomitant injury. Univariate and multivariate analysis were used to identify variables that were associated with concomitant injury. RESULTS Concomitant injury on chest CT was observed in 85 patients with sternal fracture. Of the patients, 98 (70.5%) were accompanied by retrosternal hematoma. Multivariate analysis revealed that retrosternal hematoma (odds ratio [OR] = 5.350; P < 0.001), manubrium fracture (OR = 6.848; P = 0.015), and motor vehicle accident (OR = 0.342; P = 0.015) were significantly associated with sternal fracture with concomitant injury. CONCLUSION Manubrium fracture and retrosternal hematoma portend a high risk of concomitant injury and indicate the need for further clinical and radiologic work-up.
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Affiliation(s)
- Ye Na Son
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jung Im Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Han Na Lee
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - So Youn Shin
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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14
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Ahmadinejad M, Pak H, Soltanian A, Pouryaghobi SM, Mohammadzadeh S, Ahmadi A, Ahmadinejad I. A retrospective study on the cardiac assessment of isolated sternal fracture patients based on radiographic and clinical outcomes. Ann Med Surg (Lond) 2021; 69:102762. [PMID: 34471533 PMCID: PMC8387903 DOI: 10.1016/j.amsu.2021.102762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/17/2021] [Accepted: 08/22/2021] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Sternal fracture may be associated with major and serious injuries. In this study, the complications associated with isolated sternal fracture in trauma patients are evaluated based on radiographic and cardiac findings. METHODS This retrospective study was performed on patients with isolated sternal fractures admitted to the emergency department of (XXX) Madani Educational-Medical. Data regarding demographic information, mechanism of trauma, length of hospitalization, electrocardiography (ECG), cardiac enzyme, and chest radiography were recorded in the questionnaire for each patient. RESULTS The mean age of patients 41.2 + 11.04 years and 63.9% were male. The most common cause of the trauma was car accidents in 41% (25 cases). The mean duration of hospitalization was 1.54 ± 0.90 days. The mechanism of trauma was not associated with x-ray and computed tomography findings, p = 0.53 and p = 0.86, respectively. ECG findings were significantly related to x-ray and computed tomography outcomes, p < 0.001, respectively. CONCLUSION Patients with isolated sternal fracture with displacement >0.5 cm and hematoma are likely to require cardiac consultation.
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Affiliation(s)
- Mojtaba Ahmadinejad
- Department of Surgery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Haleh Pak
- Department of Surgery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Ali Soltanian
- Department of Surgery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Seyyed Mohsen Pouryaghobi
- Department of Anesthesiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Sanaz Mohammadzadeh
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Abtin Ahmadi
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
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15
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Fuke Y, Ushijima T, Matsuyama S, Kimura S, Sonoda H, Osawa S, Maki J, Tokuda K, Momii K, Shiose A. A new combination technique of the modified Robicsek wire fixation and plate fixation achieves effective repair of transverse sternal fracture: a report of two cases. Surg Case Rep 2021; 7:182. [PMID: 34383153 DOI: 10.1186/s40792-021-01267-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/06/2021] [Indexed: 11/15/2022] Open
Abstract
Background To maximize the therapeutic effect for complicated sternal fracture, we should know advantages and disadvantages of each surgical repositioning technique, and the choice of an appropriate procedure is essential. We report two successful cases for which a combination of two existing techniques, modified Robicsek wire fixation and locked titanium plate fixation, was applied to transverse sternal fracture with flail chest. Case presentation One patient experienced a transverse sternal and rib fracture due to a traffic injury. Flail chest due to a highly displaced transverse sternal fracture made withdrawal of the ventilator impossible. Another patient, who developed fulminant myocarditis, experienced a transverse sternal fracture resulting from chest compression during cardiopulmonary resuscitation. Severe paradoxical respiratory movement was a limiting factor for cardiac and respiratory rehabilitation. In both cases, a transverse sternal fracture was difficult to correct non-invasively and indicated surgical repair. The surgical repositioning and fixation greatly contributed to the improvement of the respiratory movement, and the patients were successfully withdrawn ventilator support. Conclusion The combination of modified Robicsek wire fixation and locked titanium plate fixation for a complicated sternal fracture employs the complementary and comparative advantages of each procedure and effective fixation may be achieved.
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16
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Xu S, Zhu J, Yu Q, Peng L, Tao Y, Qi S, Han H, Liu Y. Surgical treatment of sternum comminuted fracture with memory alloy embracing fixator. J Thorac Dis 2021; 13:2194-2202. [PMID: 34012570 PMCID: PMC8107563 DOI: 10.21037/jtd-20-3603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Sternal fracture can result from multiple types of severe chest trauma and carries significant risk. Surgical fixation is an effective method for sternal fracture. Methods The clinical data of patients with sternal fractures who presented to our hospital between August 2016 and July 2019 were collected. The 42 patients were divided into three groups, with 15 patients treated by internal fixation with NI-TI memory alloy embracing fixator, 10 patients receiving steel wire fixation, and 17 who received non-surgical treatment and who was designated as a control (conservative) group. Differences in clinical indices included the duration of surgery, blood loss, hospitalization, wound healing, hospitalization expenses, VAS scores, and patient satisfaction scores between the three groups was compared. The analysis of variance and t-test were used for quantitative variables, which were approximately normally distributed. Dichotomous data were compared used Pearson χ2 or Fisher’s exact test, and a P value less than 0.05 was considered as statistically significant. Results All patients were cured, and there were no significant differences in general clinical features between the three groups (P>0.05). Thoracic deformity in the surgical groups was corrected anatomically and received better pain scores, while patients in the NI-TI memory alloy embracing fixator group showed advantages of bleeding and patient satisfaction (P<0.05). Conclusions Operative treatment for a sternal fracture is safe, effective and can quickly restore the stability of the thorax. Memory alloy embracing fixator is markedly superior to other fixator materials.
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Affiliation(s)
- Shun Xu
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China.,Department of Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Zhu
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Qi Yu
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Leilei Peng
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Yu Tao
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Shengbo Qi
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Hao Han
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Yongjing Liu
- Department of Thoracic Surgery, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
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17
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Ma DS, Ryu JW, Noh D. Direct cardiac rupture associated with sternal fracture following blunt trauma: A report of two case. Trauma Case Rep 2021; 32:100430. [PMID: 33665322 DOI: 10.1016/j.tcr.2021.100430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 11/21/2022] Open
Abstract
Traumatic cardiac injury is not rare. Especially cardiac contusion with sternal fracture due to blunt trauma in common. But cardiac rupture due to direct injury from fractured sternum in very rare. There were two case of cardiac injury supposed to be due to direct injury from fractured sternum. We operated immediately, so we could save these patients. Our cases show that it's rare but blunt trauma could make sternum fracture with direct injury to right side heart.
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18
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Spering C, von Hammerstein-Equord A, Lehmann W, Dresing K. [Osteosynthesis of the unstable thoracic wall]. Oper Orthop Traumatol 2020; 33:262-284. [PMID: 33289872 PMCID: PMC7722258 DOI: 10.1007/s00064-020-00688-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 03/08/2020] [Accepted: 03/29/2020] [Indexed: 11/27/2022]
Abstract
Operationsziel Wiederherstellung einer normalen Atemmechanik und Vermeidung beatmungsassoziierter Komplikationen durch operative Stabilisierung eines instabilen Thorax bei dislozierten Rippenserien- und Sternumfrakturen, posttraumatischer Thoraxwanddeformierung, Weaning-Versagen und symptomatischen Rippenpseudarthrosen. Indikationen Kombination mehrerer klinischer und radiologischer Parameter wie das Ausmaß der Rippenserien- und Sternumfrakturen, der Grad der Dislokation, pathophysiologische Veränderungen der Atemmechanik, Versagen eines konservativen Therapieansatzes. Kontraindikationen Akute hämodynamische Instabilität und Zeichen einer systemischen Infektion. Operationstechnik Detaillierte präoperative Planung. Offene, möglichst minimalinvasive Reposition und winkelstabile Osteosynthese mit anatomisch vorgeformten Low-profile-Platten und/oder intramedullären Splints. Vorsichtige Repositionsmanöver und Einbringen der Implantate aufgrund enger Lagebeziehung zu Pleuraspalt, Lunge und Perikard. Weiterbehandlung Möglichst frühzeitiges postoperatives Entwöhnen vom Respirator sowie frühzeitige Therapie eines perioperativen Pneumothorax. Eine Implantatentfernung ist in der Regel nicht notwendig. Ergebnisse In einer retrospektiven Untersuchung profitierten 15 Polytraumapatienten mit instabilem Thorax von der frühen operativen Stabilisierung des Thorax innerhalb von 24–48 h und einer differenzierten, interdisziplinären Behandlungsstrategie. Beatmungsdauer und Pneumonierate waren in der Subgruppe der frühzeitig operierten signifikant niedriger als in der Gruppe der später operativ an der Thoraxwand stabilisierten Patienten. In den Subgruppen der lebensgefährlich Verletzten mit Thoraxtrauma (LVK-Thx und LOTX [LVK-Thx mit Osteosynthese am Thorax]) konnten eine längere Beatmungszeit, Intensivtherapie, Krankenhausverweildauer sowie eine erhöhte beatmungsassoziierte Komplikationsrate als in der Subgruppe der Schwerverletzten ohne Thoraxtrauma (AIS [Abbreviated Injury Scale] ≥ 3) gezeigt werden.
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Affiliation(s)
- Christopher Spering
- Klink für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | | | - Wolfgang Lehmann
- Klink für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Klaus Dresing
- Klink für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
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Chalphin AV, Mooney DP. Pediatric sternal fractures: A single center retrospective review. J Pediatr Surg 2020; 55:1224-7. [PMID: 31711745 DOI: 10.1016/j.jpedsurg.2019.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/29/2019] [Accepted: 10/10/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE We sought to investigate the diagnosis, management, and outcomes of pediatric sternal fractures. METHODS We used ICD codes to search our trauma registry and Hound Dog software to search the hospital data warehouse for all cases of radiologically confirmed sternal fracture in patients <21 years from January 1, 1997 to July 1, 2017. We extracted demographics, mechanism of injury, diagnostic modality, associated injuries, and clinical outcomes. RESULTS We identified 65 children with sternal fractures. 46/65 (71%) were male, with median age 11 years. 34/65 (52%) presented to our emergency department (ED) and the remainder to outpatient clinics. 41/65 (63%) were diagnosed by chest X-ray, 11/65 (17%) by chest CT, 7/65 (11%) by sternal X-ray, and 5/65 (8%) by MRI. Mechanism of injury varied by age. The majority, 50/65 (77%), were isolated injuries and there were no cardiac injuries, aortic injuries or deaths. 18/33 (45%) of those who presented initially to the ED were admitted, and of these 7/18 (39%) had isolated sternal fractures. CONCLUSIONS In this series, most sternal fractures were isolated with low morbidity. Sternal fracture alone should not prompt aggressive workup for intrathoracic injuries and stable patients with isolated sternal fractures can be safely followed without admission. LEVEL OF EVIDENCE IV.
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20
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Aserlind AB, Burnweit CA. Spontaneous sternal fracture during labor in a healthy primigravida with female athlete triad: A case report. Case Rep Womens Health 2020; 27:e00213. [PMID: 32435601 PMCID: PMC7229480 DOI: 10.1016/j.crwh.2020.e00213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction This case raises awareness of the diagnosis of sternal fracture during labor and obviates the need for lengthy, expense-consuming workup. This report identifies a subset of women who may be at higher risk for this pathology. Methods Upon diagnosing and treating a patient who spontaneously fractured her sternum during labor, we reviewed previously reported cases and highlight key points of this entity. Results We report the third case of sternal fracture during labor in a healthy primigravida with female athlete triad. After 12 h of labor, the woman underwent epidural placement. By 16 h, the cervix was fully dilated. During the second push in the chin-to-chest position, a healthy baby was delivered, but the mother experienced acute anterior chest pain. Tenderness persisted for three weeks. Plain radiographs confirmed the presence of the fracture, which healed spontaneously. Conclusion While chest pain during labor often results from serious causes including pulmonary embolism, myocardial infarction, and spontaneous pneumothorax, hyperflexion sternal fracture can occur, particularly in a woman with female athlete triad.
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Affiliation(s)
- Alexandra B Aserlind
- Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, USA
| | - Cathy A Burnweit
- Department of Pediatric Surgery, Nicklaus Children's Hospital, Miami, Florida, USA
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21
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Weiß T, Klöpfer-Krämer I, Hauck S, Gonschorek O, Högel F. Clinical and radiological evaluation of thoracic spine fractures with or without sternal fracture: is there a need for ventral stabilization? Eur J Trauma Emerg Surg 2020; 47:733-737. [PMID: 32161975 DOI: 10.1007/s00068-019-01280-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/02/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The treatment of thoracic spine (TS) fractures with additional sternal fractures compared to TS fractures without sternal fractures is discussed controversionally, because in some studies it was stated that sternal fractures decrease the thoracic stability. We hypothesized that both types of fractures can be treated the same way by posterior stabilization alone. METHODS A total number of 69 patients with thoracic fractures, with or without additional sternal fractures, were examined, regarding the angle of kyphosis after fracture, postoperatively and after 6 and 12 months. We also recorded the outcome using the Odom's score and the time until patients returned to work and the activity level. RESULTS It was found that the angle of kyphosis was nearly physiological after stabilization in both groups and a loss of reduction after 1 year was also comparable, either in the patients suffering from the additional sternal fracture or not. In addition, the Odom's score and the time until return to work and the activity level were comparable in both groups. CONCLUSION We did not find any arguments to preserve additional anterior stabilization or reasons for different treatment strategies either additional sternal fractures occur in thoracic spine fractures or not.
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Affiliation(s)
- Thomas Weiß
- Department of Trauma Surgery, BG Trauma Centre Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany
| | - Isabella Klöpfer-Krämer
- Institute for Biomechanics, PMU Salzburg and BG Trauma Centre Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany
| | - Stefan Hauck
- Department of Trauma Surgery, BG Trauma Centre Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany
| | - Oliver Gonschorek
- Department of Trauma Surgery, BG Trauma Centre Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany
| | - Florian Högel
- Department of Trauma Surgery, BG Trauma Centre Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany.
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22
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Imanishi N, Takeda Y, Ichiki Y, Tanaka F. Thoracoscopy-assisted repair of comminuted sternal fracture with bioresorbable plates. Interact Cardiovasc Thorac Surg 2019; 29:478-480. [PMID: 31134277 DOI: 10.1093/icvts/ivz118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/10/2019] [Accepted: 04/14/2019] [Indexed: 11/13/2022] Open
Abstract
We present a case of comminuted sternal fracture with posterior displacement, which was successfully repaired by 'sandwich' fixation using 2 bioresorbable plates that were placed anterior to and posterior to the sternum. All procedures including retro-sternal dissection for placement of the posterior plate were performed using video-assisted thoracoscopic surgery. The minimally invasive thoracoscopic technique provided effective repair and rigid fixation with immediate relief from intractable chest pain that had persisted before surgery.
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Affiliation(s)
- Naoko Imanishi
- Second Department of Surgery (Chest Surgery), University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yusuke Takeda
- Second Department of Surgery (Chest Surgery), University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshinobu Ichiki
- Second Department of Surgery (Chest Surgery), University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Fumihiro Tanaka
- Second Department of Surgery (Chest Surgery), University of Occupational and Environmental Health, Kitakyushu, Japan
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23
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Kalberer N, Frima H, Michelitsch C, Kloka J, Sommer C. Osteosynthesis of sternal fractures with double locking compression plate fixation: a retrospective cohort study. Eur J Orthop Surg Traumatol 2019; 30:75-81. [PMID: 31456035 DOI: 10.1007/s00590-019-02526-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/02/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE Sternal fractures are rare injuries and mostly treated non-operatively. In selected cases, internal fixation becomes necessary. No standard operative approach has been determined yet among experts. The aim of this study is to describe our treatment algorithm and results after operative stabilisation of sternal fractures with locking compression plates (LCP), mainly focusing on the functional outcome. METHODS A retrospective cohort study was conducted. We included all patients after operative stabilisation of a sternal fracture between 2008 and 2016. Endpoints were the functional outcome using the Activities of Daily Living (ADL) score, pain analysed by the numeric rating scale (NRS), breathing ability, complications and implant removal. RESULTS Eighteen out of 153 (12%) patients with a sternal fracture underwent operation. Three patients were lost to follow-up. Eleven out of 15 (73%) patients were treated with double straight LCP 3.5 mm implants and 4 (27%) patients with pre-countered LCP 3.5 mm implants. Mean follow-up was 57 months. The median ADL score was 1 (1-4), the median NRS was 0 (0-9), and respiratory complaints scored a median of 1 (1-4). No non-union, hardware failure or implant-related complication occurred. Post-operative complications were pneumonia (20%) and respiratory insufficiency (20%). Implants were removed in 4/15 (27%) patients; three times due to implant-related irritation, once on patient's request. CONCLUSION Operative stabilisation of sternal fractures with double LCP 3.5 mm provides excellent long-term functional results and seems to be an appropriate option for internal fixation. The rate of post-operative complications is low; however, 27% had a second operation for implant removal.
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Affiliation(s)
- Nina Kalberer
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
| | - Herman Frima
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland.
| | - Christian Michelitsch
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
| | - Jan Kloka
- Department of Anaesthesiology, Universitätsklinikum Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Christoph Sommer
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
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Xie ZX, Zhou XT, Zhang DS, Yang Y, Zhang GL, Chen MH, Liang Z. Minimally invasive plate osteosynthesis for the treatment of sternal fracture in the lower chest: a case report. J Int Med Res 2019; 47:4033-4038. [PMID: 31364423 PMCID: PMC6726812 DOI: 10.1177/0300060519865074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Sternal fracture is a common complication of chest trauma but has a low incidence. Various treatments have been developed to reconstruct sternal fractures. Among these approaches, analgesia, corset fixation, and open reduction with plate internal fixation have been suggested. The use of newly developed minimally invasive plate osteosynthesis is a feasible method. In this study, we report a case involving a 54-year-old man with a sternal fracture accompanied by bilateral pleural effusion and a small amount of right-sided pneumothorax. The patient was treated with minimally invasive plate osteosynthesis. The operation was successful and the postoperative recovery was good. No pneumothorax or complications such as chest pain, paresthesia, or wound infection were observed at the 1-year follow-up visit. Additionally, the bilateral pleural effusion had been completely absorbed. The incision in the lower chest was aesthetic and minimally traumatic. This case describes a novel method for internal fixation of sternal fractures.
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Affiliation(s)
- Ze-Xin Xie
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, Shijiazhuang, China
| | - Xue-Tao Zhou
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, Shijiazhuang, China
| | - Dong-Sheng Zhang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, Shijiazhuang, China
| | - Yang Yang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, Shijiazhuang, China
| | - Guo-Liang Zhang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, Shijiazhuang, China
| | - Meng-Hui Chen
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, Shijiazhuang, China
| | - Zheng Liang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, Shijiazhuang, China
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Jiang WY, Chen YL, Xu NJ, Hu XD, Ruan CY, Ma WH. Missed manubriosternal dislocation in patient with thoracolumbar fracture, a case report. BMC Surg 2019; 19:101. [PMID: 31357976 DOI: 10.1186/s12893-019-0564-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/18/2019] [Indexed: 11/30/2022] Open
Abstract
Background Spine fractures combined with sternal injury are most commonly occur in the thoracic region. Lower cervical and thoracolumbar injuries have also been reported, especially for the patients with manubriosternal dislocation. The type of spine injury is easily recognized in initial presentation, but we may miss the sternal fracture and manubriosternal dislocation. Case presentation A 23-year-old male patient complained with chest, right ankle, and lumbar pain after a fall at ground level, with diagnosis of right distal tibial fracture, sternal fracture, calcaneus fracture, and L2 vertebral fracture. However, neurologically he was completely normal. He underwent the operation for his lower extremity and spine, but we missed his manubriosternal dislocation after discharged. After one month, he came to the clinic with complained of chest pain, the imaging exams showed anterior dislocation of manubriosternal joint. We chose conservative treatment for manubriosternal dislocation. He was followed up at monthly intervals and radiographs along with computerized tomography showed satisfactory in fracture healing of lumber and the sternal fracture. However, the manubriosternal dislocation was malunioned. The patient had appearance deformity of the manubriosternal joint. Conclusion This case supports the concept of the existence and clinical relevance of the thoracic cage theory, the thoracolumbar vertebrae should also be included in the thoracic cage theory.
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Rosenfeld EH, Lau P, Shah SR, Naik-Mathuria B, Wesson DE, Wakeman DS, Vogel AM. Sternal fractures in children: An analysis of the National Trauma Data Bank. J Pediatr Surg 2019; 54:980-3. [PMID: 30770129 DOI: 10.1016/j.jpedsurg.2019.01.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 01/27/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to describe the epidemiology and evaluate the clinical significance of traumatic sternal fractures. METHODS Patients age ≤18 years with sternal fractures in the National Trauma Database research datasets from 2007-2014 were identified. Patient demographics, injuries, procedures, and outcomes were analyzed using descriptive statistics and logistic regression. RESULTS Three thousand one hundred sixty patients with sternal fracture were identified. Ninety percent of injuries occurred in patients between 12 and 18 years old. Median injury severity score (ISS) was 17 [9,29]. Exploratory thoracotomy was performed in 1%. Thirty-nine percent were admitted to the intensive care unit (ICU). On multivariate regression, predictors of ICU stay >1 day were increasing ISS, lack of the use of protective devices, decreasing Glasgow Coma Score (GCS), tachycardia, and pulmonary contusion. Median hospital length of stay was 4 [2, 9] days. In-hospital mortality was 8%. Predictors of mortality were lower GCS, increasing ISS, decreasing oxygen saturation, hypotension, and cardiac arrest. Use of protective devices and seat belts did not affect mortality. CONCLUSION Sternal fractures in patients increase in incidence with age, and poor outcomes are impacted by associated injuries and complications. The presence of a sternal fracture should trigger a careful diagnostic evaluation. LEVEL OF EVIDENCE III STUDY TYPE: Treatment Study.
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Abstract
A 35-year-old woman was involved in a motor vehicle collision and suffered a manubriosternal joint dislocation with posterior subluxation of the manubrium. She underwent open reduction and internal fixation with sternal plate reconstruction. This report highlights the mechanism and management of these rare traumatic chest wall injuries.
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Affiliation(s)
- Amir A Sarkeshik
- Division Cardiothoracic Surgery, University of California Davis, Sacramento, CA, United States of America
| | - Ala Jamal
- Division Cardiothoracic Surgery, University of California Davis, Sacramento, CA, United States of America
| | - Paul A Perry
- Division Cardiothoracic Surgery, University of California Davis, Sacramento, CA, United States of America
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Grigorian A, Milliken J, Livingston JK, Spencer D, Gabriel V, Schubl SD, Kong A, Barrios C, Joe V, Nahmias J. National risk factors for blunt cardiac injury: Hemopneumothorax is the strongest predictor. Am J Surg 2018; 217:639-642. [PMID: 30060913 DOI: 10.1016/j.amjsurg.2018.07.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/20/2018] [Accepted: 07/24/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Blunt cardiac injury (BCI) can occur after chest trauma and may be associated with sternal fracture (SF). We hypothesized that injuries demonstrating a higher transmission of force to the thorax, such as thoracic aortic injury (TAI), would have a higher association with BCI. METHODS We queried the National Trauma Data Bank (NTDB) from 2007-2015 to identify adult blunt trauma patients. RESULTS BCI occurred in 15,976 patients (0.3%). SF had a higher association with BCI (OR = 5.52, CI = 5.32-5.73, p < 0.001) compared to TAI (OR = 4.82, CI = 4.50-5.17, p < 0.001). However, the strongest independent predictor was hemopneumothorax (OR = 9.53, CI = 7.80-11.65, p < 0.001) followed by SF and esophageal injury (OR = 5.47, CI = 4.05-7.40, p < 0.001). CONCLUSION SF after blunt trauma is more strongly associated with BCI compared to TAI. However, hemopneumothorax is the strongest predictor of BCI. We propose all patients presenting after blunt chest trauma with high-risk features including hemopneumothorax, sternal fracture, esophagus injury, and TAI be screened for BCI. SUMMARY Using the National Trauma Data Bank, sternal fracture is more strongly associated with blunt cardiac injury than blunt thoracic aortic injury. However, hemopneumothorax was the strongest predictor.
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Affiliation(s)
- Areg Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA.
| | - Jeffrey Milliken
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Joshua K Livingston
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Dean Spencer
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Viktor Gabriel
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Sebastian D Schubl
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Allen Kong
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Cristobal Barrios
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Victor Joe
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
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Miller D, Akhtar MA, Fergusson J, McVie JL. A novel method of open reduction and internal fixation of a displaced manubrial fracture using distal clavicle locking plates. Interact Cardiovasc Thorac Surg 2017. [PMID: 28637185 DOI: 10.1093/icvts/ivx185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 52-year-old man sustained a sternal fracture after a blunt traumatic chest injury. He was in severe pain in the intensive care unit, which resulted in difficulty breathing and increased analgesic requirement, and a decision was made to stabilize his manubrial fracture. Orthopaedic and thoracic surgeons jointly performed open reduction and internal fixation of the displaced manubrial fracture using 2 distal clavicle locking plates. This resulted in improvement in patient's pain and helped with his subsequent recovery and discharge from the hospital. This case report describes a new, safe and effective method of treating this uncommon injury.
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Affiliation(s)
- Daniel Miller
- Undergraduate Education, LRI, James Cook University Hospital, Middlesbrough, UK.,Department of Trauma and Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - M Adeel Akhtar
- Department of Trauma and Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Jonathan Fergusson
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - James L McVie
- Department of Trauma and Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, UK
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Piggott RP, Curtin M, Munigangaiah S, Jadaan M, McCabe JP, Devitt A. Sternal metastasis - the forgotten column and its effect on thoracic spine stability. World J Orthop 2017; 8:455-460. [PMID: 28660136 PMCID: PMC5478487 DOI: 10.5312/wjo.v8.i6.455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/01/2017] [Accepted: 04/24/2017] [Indexed: 02/06/2023] Open
Abstract
Sternal metastases are not studied extensively in the literature. There is a paucity of information on their role in metastatic disease. The concept of the fourth column was described by Berg in 1993, and has been proven in case report, clinically and biomechanical studies. The role of the sternum as a support to the thoracic spine is well documented in the trauma patients, but not much is known about its role in cancer patients. This review examines what is known on the role of the fourth column. Following this we have identified two likely scenarios that sternal metastases may impact management: (1) sternal pathological fracture increases the mobility of the semi-rigid thorax with the loss of the biomechanical support of the sternum-rib-thoracic spine complex; and (2) a sternal metastasis increases the risk of fracture, and while being medical treated the thoracic spine should be monitored for acute kyphosis and neurological injury secondarily to the insufficiency of the fourth column.
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Zhao Y, Yang Y, Gao Z, Wu W, He W, Zhao T. Treatment of traumatic sternal fractures with titanium plate internal fixation: a retrospective study. J Cardiothorac Surg 2017; 12:22. [PMID: 28376814 PMCID: PMC5379527 DOI: 10.1186/s13019-017-0580-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/20/2017] [Indexed: 11/18/2022] Open
Abstract
Background This study aim to evaluate surgical procedures for titanium plate internal fixation of sternal fractures with displacement or nonunion. Methods From January 2010 to December 2014, 64 patients with sternal fractures were treated with titanium plate internal fixation in the thoracic surgery department of the Shanghai Sixth People’s Hospital. Pain severity scale scores were analyzed preoperatively and postoperatively. All the patients had a 2-month follow-up for treatment evaluation. Results The mean hospital length of stay was 16.89 days. Forty-five patients underwent surgery for combined injuries. A statistically significant difference (P < 0.05) was found between preoperative and postoperative pain severity scores (7.74 ± 0.89 vs. 3.80 ± 0.79, respectively). At follow-up, healing of the nonunion or fracture was confirmed in all the cases. Conclusion The rigid titanium plate application ensured a safe and easy management of traumatic sternal fractures and nonunion with a good prognosis as compared with other methods.
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Affiliation(s)
- Yonghong Zhao
- Department of Thoracic Surgery, Shanghai Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Yi Yang
- Department of Thoracic Surgery, Shanghai Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Zongli Gao
- Department of Thoracic Surgery, Shanghai Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Weiming Wu
- Department of Thoracic Surgery, Shanghai Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Weiwei He
- Department of Thoracic Surgery, Shanghai Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Tiancheng Zhao
- Department of Thoracic Surgery, Shanghai Sixth People's Hospital, Shanghai, 200233, People's Republic of China.
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Morgenstern M, von Rüden C, Callsen H, Friederichs J, Hungerer S, Bühren V, Woltmann A, Hierholzer C. The unstable thoracic cage injury: The concomitant sternal fracture indicates a severe thoracic spine fracture. Injury 2016; 47:2465-2472. [PMID: 27592182 DOI: 10.1016/j.injury.2016.08.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 05/09/2016] [Accepted: 08/28/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The thoracic cage is an anatomical entity composed of the upper thoracic spine, the ribs and the sternum. The aims of this study were primarily to analyse the combined injury pattern of thoracic cage injuries and secondarily to evaluate associated injuries, trauma mechanism, and clinical outcome. We hypothesized that the sternal fracture is frequently associated with an unstable fracture of the thoracic spine and that it may be an indicator for unstable thoracic cage injuries. PATIENTS AND METHODS Inclusion criteria for the study were (a) sternal fracture and concomitant thoracic spine fracture, (b) ISS≥16, (c) age under 50 years, (d) presence of a whole body computed-tomography performed at admission of the patient to the hospital. Inclusion criteria for the control group were as follows: (a) thoracic spine fracture without concomitant sternal fracture, (b)-(d) same as study cohort. RESULTS In a 10-year-period, 64 patients treated with a thoracic cage injury met inclusion criteria. 122 patients were included into the control cohort. In patients with a concomitant sternal fracture, a highly unstable fracture (AO/OTA type B or C) of the thoracic spine was detected in 62.5% and therefore, it was significantly more frequent compared to the control group (36.1%). If in patients with a thoracic cage injury sternal fracture and T1-T12 fracture were located in the same segment, a rotationally unstable type C fracture was observed more frequently. The displacement of the sternal fracture did not influence the severity of the concomitant T1-T12 fracture. CONCLUSIONS The concomitant sternal fracture is an indicator for an unstable burst fracture, type B or C fracture of the thoracic spine, which requires surgical stabilization. If sternal and thoracic spine fractures are located in the same segment, a highly rotationally unstable type C fracture has to be expected.
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Affiliation(s)
- Mario Morgenstern
- Department of Trauma Surgery, Trauma Center Murnau, Murnau, Germany; Department of Orthopaedic Surgery and Traumatology, University Hospital Basel, Switzerland; Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria.
| | - Christian von Rüden
- Department of Trauma Surgery, Trauma Center Murnau, Murnau, Germany; Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
| | - Hauke Callsen
- Department of Trauma Surgery, Trauma Center Murnau, Murnau, Germany
| | - Jan Friederichs
- Department of Trauma Surgery, Trauma Center Murnau, Murnau, Germany
| | - Sven Hungerer
- Department of Trauma Surgery, Trauma Center Murnau, Murnau, Germany; Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
| | - Volker Bühren
- Department of Trauma Surgery, Trauma Center Murnau, Murnau, Germany
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Thomas KP, Sainudeen S, Jose S, Nadhari MY, Macaire PB. Ultrasound-Guided Parasternal Block Allows Optimal Pain Relief and Ventilation Improvement After a Sternal Fracture. Pain Ther 2016; 5:115-22. [PMID: 27001634 PMCID: PMC4912971 DOI: 10.1007/s40122-016-0050-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Indexed: 12/29/2022] Open
Abstract
Introduction Sternal fractures are a painful condition which can result in pulmonary morbidity if not treated promptly. The management of isolated fractures has changed from hospital to home-based treatment, provided other major injuries have been excluded. Pain management is the mainstay of treatment. In this case report, we describe how a parasternal block under ultrasound guidance for sternal fracture provided better analgesia thereby improving ventilation. Case report A 26-year-old man was admitted to the emergency department following a road traffic accident. His initial evaluation revealed a radio-cubital displaced fracture at the elbow level with severe tenderness over the sternum. Chest X-ray on admission did not reveal any abnormality. On preoperative checkup he was found to have altered chest mechanics with severe pain and tenderness over the sternum. Arterial blood gas (ABG) analysis showed respiratory acidosis. Pulmonary electrical impedance tomography showed hypoventilation of anterior portions of both lungs. An ultrasound examination of the sternum showed a fractured sternum with complete disjunction. An ultrasound-guided bilateral parasternal block was performed which resulted in efficient analgesia and thereby improved his ventilation as indicated by the improvement in ABG. Conclusion Timely and proper analgesia can reduce the pulmonary morbidity in sternal fractures. Of the various analgesic techniques, parasternal block under ultrasound guidance is a relatively simple, safe, and target-specific procedure that can provide efficient pain relief. Electronic supplementary material The online version of this article (doi:10.1007/s40122-016-0050-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kurian P Thomas
- Department of Anesthesiology, Rashid Hospital-Trauma Centre, Dubai Health Authority, Dubai, United Arab Emirates
| | - Shaji Sainudeen
- Department of Anesthesiology, Rashid Hospital-Trauma Centre, Dubai Health Authority, Dubai, United Arab Emirates
| | - Suraj Jose
- Department of Anesthesiology, Rashid Hospital-Trauma Centre, Dubai Health Authority, Dubai, United Arab Emirates
| | - Mansour Y Nadhari
- Department of Anesthesiology, Rashid Hospital-Trauma Centre, Dubai Health Authority, Dubai, United Arab Emirates
| | - Philippe B Macaire
- Department of Anesthesiology, Rashid Hospital-Trauma Centre, Dubai Health Authority, Dubai, United Arab Emirates.
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Perez MR, Rodriguez RM, Baumann BM, Langdorf MI, Anglin D, Bradley RN, Medak AJ, Mower WR, Hendey GW, Nishijima DK, Raja AS. Sternal fracture in the age of pan-scan. Injury 2015; 46:1324-7. [PMID: 25817167 DOI: 10.1016/j.injury.2015.03.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 02/08/2015] [Accepted: 03/05/2015] [Indexed: 02/02/2023]
Abstract
STUDY OBJECTIVE Widespread chest CT use in trauma evaluation may increase the diagnosis of minor sternal fracture (SF), making former teaching about SF obsolete. We sought to determine: (1) the frequency with which SF patients are diagnosed by CXR versus chest CT under current imaging protocols, (2) the frequency of surgical procedures related to SF diagnosis, (3) SF patient mortality and hospital length of stay comparing patients with isolated sternal fracture (ISF) and sternal fracture with other thoracic injury (SFOTI), and (4) the frequency and yield of cardiac contusion (CC) workups in SF patients. METHODS We analyzed charts and data of all SF patients enrolled from January 2009 to May 2013 in the NEXUS Chest and NEXUS Chest CT studies, two multi-centre observational cohorts of blunt trauma patients who received chest imaging for trauma evaluation. RESULTS Of the 14,553 patients in the NEXUS Chest and Chest CT cohorts, 292 (2.0%) were diagnosed with SF, and 94% of SF were visible on chest CT only. Only one patient (0.4%) had a surgical procedure related to SF diagnosis. Cardiac contusion was diagnosed in 7 (2.4%) of SF patients. SF patient mortality was low (3.8%) and not significantly different than the mortality of patients without SF (3.1%) [mean difference 0.7%; 95% confidence interval (CI) -1.0 to 3.5%]. Only 2 SF patient deaths (0.7%) were attributed to a cardiac cause. SFOTI patients had longer hospital stays but similar mortality to patients with ISF (mean difference 0.8%; 95% CI -4.7% to 12.0). CONCLUSIONS Most SF are seen on CT only and the vast majority are clinically insignificant with no change in treatment and low associated mortality. Workup for CC in SF patients is a low-yield practice. SF diagnostic and management guidelines should be updated to reflect modern CT-driven trauma evaluation protocols.
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Affiliation(s)
- Michael R Perez
- Department of Emergency Medicine, The University of California San Francisco, United States.
| | - Robert M Rodriguez
- Department of Emergency Medicine, The University of California San Francisco, United States
| | - Brigitte M Baumann
- Department of Emergency Medicine, Cooper Medical School of Rowan University, United States
| | - Mark I Langdorf
- Department of Emergency Medicine, University of California Irvine, United States
| | - Deirdre Anglin
- Department of Emergency Medicine, Keck School of Medicine - University of Southern California, United States
| | - Richard N Bradley
- Department of Emergency Medicine, The University of Texas Health Science Center at Houston, United States
| | - Anthony J Medak
- University of California San Diego School of Medicine, Department of Emergency Medicine, United States
| | - William R Mower
- Department of Emergency Medicine, University of California Los Angeles, United States
| | - Gregory W Hendey
- Department of Emergency Medicine, University of California San Francisco Fresno Medical Education Program, United States
| | - Daniel K Nishijima
- Department of Emergency Medicine, University of California Davis, United States
| | - Ali S Raja
- Department of Emergency Medicine, Brigham and Women's Hospital/Harvard Medical School, United States
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Schulz-Drost S, Oppel P, Grupp S, Taylor D, Krinner S, Langenbach A, Hennig F, Mauerer A. The oblique fracture of the manubrium sterni caused by a seatbelt--a rare injury? Treatment options based on the experiences gained in a level I trauma centre. Int Orthop 2016; 40:791-8. [PMID: 25957589 DOI: 10.1007/s00264-015-2801-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Sternal fractures are rare with 3-8 % out of the total number of trauma cases mostly caused by direct impact to the anterior chest wall. Most cases described are due to motor vehicle crash either caused by direct impact to the steering wheel or by the seat belt. Fractures mainly occur to the sternal body. Only rarely are cases of manubrium fractures described in literature, for example, in relationship with a direct impact to the shoulder which caused an oblique fracture near to the sternoclavicular joint. Three patients with profoundly dislocated oblique manubrium fracture were admitted to our Level I Trauma Center in 2012 and 2013. Those patients suffered from instability of the upper sternum and the shoulder girdle. MATERIAL AND METHODS Between January 2012 and October 2013, a total of 538 trauma patients were admitted to the emergency room and received whole body CT-scan. They were analysed retrospectively for sternal fractures. In cases of instability and dislocation, fracture stabilisation was performed by anterior plating through a medial approach using low profile titanium plates (MatrixRib®). RESULTS Seventy-nine (14.7 %) patients showed sternal fracture, out of which 13 (2.4 %) patients showed a fracture of manubrium, ten caused by seatbelt. In three cases stabilization was performed. Follow up showed sufficient consolidation without complications. DISCUSSION A total of 16.5 % of sternal fractures were localized at the manubrium, mostly caused by seat belt. Fractures without significant dislocation seemed to be stable and healed well under conservative treatment. Dislocation in this region leads to unstable shoulder girdle. Anterior plating provides sufficient stabilisation and allowed consolidation.
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Yeh DD, Hwabejire JO, DeMoya MA, Alam HB, King DR, Velmahos GC. Sternal fracture--an analysis of the National Trauma Data Bank. J Surg Res 2014; 186:39-43. [PMID: 24135374 DOI: 10.1016/j.jss.2013.08.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 08/23/2013] [Accepted: 08/27/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND The clinical significance of sternal fractures (SFs) after blunt trauma is heavily debated. We aimed to test the hypothesis that isolated SF is not associated with significant morbidity or mortality. MATERIALS AND METHODS The National Trauma Data Bank (NTDB) sets for 2007-2010 were retrospectively examined. Adult subjects with SF were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. Data collected included demographics, mechanisms of injury, clinical variables, and in-hospital mortality. The primary outcome measure was in-hospital mortality. Secondary outcome measures included hospital length of stay, intensive care unit days, and ventilator days. RESULTS A total of 32,746 subjects with SF were included. Motor vehicle crash (MVC) was the most common mechanism (84%) in this group and SF was present in 3.7% of all patients admitted after MVC. The mean age was 51 y, 66% were males, and most were white (74%). Overall in-hospital mortality was 8.8% and mortality with isolated SF was 3.5%. Increasing thoracic fracture burden (rib fracture, clavicular fracture, and scapular fracture) was associated with increasing hospital length of stay, intensive care unit days, ventilator days, and mortality. On multivariate regression analysis, other significant predictors of mortality were cardiac arrest, acute respiratory distress syndrome, pulmonary embolism, blunt cardiac injury, pulmonary contusion, increasing age, and lack of insurance. CONCLUSIONS SFs occur in 3.7% of victims after MVC. With isolated SF, the mortality rate is low (3.5%); the tendency for poorer outcomes is most heavily influenced by associated injuries (pulmonary contusions, other thoracic fractures), complications (cardiac arrest, pulmonary embolism, acute respiratory distress syndrome), comorbidities (currently on or requiring dialysis, residual neurologic deficit from stroke), and lack of insurance.
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