Injuries significantly associated with thoracic spine fractures: a case-control study

Open reduction internal fixation of rib fractures: a biomechanical comparison between the RibLoc U Plus® system and anterior plate in rib implants

OBJECTIVES

In this study, we assessed the bending strength of two surgical repairs of rib fracture using RibLoc^® U Plus system made by Acute Innovations and the anterior plate by Synthes.

METHODS

After a rib fracture was created in seven pairs of cadaveric rib specimens, one side was repaired with the anterior plate and the other side repaired with the RibLoc U Plus^® plate. Each of the rib is loaded using a custom device over 360,000 bending cycles to simulate in vivo fatiguing related to respiration. Upon completion of the cyclic loading, the specimens were compressively loaded to failure and the failure bending moment was determined.

RESULTS

The ribs repaired with the RibLoc U Plus^® system showed 79% higher failure bending moment than that of the anterior plate, with a p value of 0.033. The ribs repaired with RibLoc U Plus^® showed a trend of less stiffness reduction over the 360,000 loading cycles.

CONCLUSION

The biomechanical study showed that the RibLoc U Plus^® system is stronger in the bending moment loading of repaired ribs, possibly due to the U-shape structure supporting both the inner and outer cortices of a repaired rib.

Traumatic sternal injury in patients with rib fracture: A single-center experience

Purpose:

We aimed to assess the pattern and impact of sternal injury with rib fracture in a Level 1 trauma center.

Patients and Methods:

We conducted a retrospective review of trauma registry data to identify patients who presented with sternal fracture between 2010 and 2017. Data were analyzed and compared in patients with and without rib fracture.

Results:

We identified 212 patients with traumatic sternal injury, of them 119 (56%) had associated rib fractures. In comparison to those who had no rib fracture, patients with rib fractures were older (40.1 ± 13.6 vs. 37.8 ± 14.5), were frequently involved in traffic accidents (75% vs. 71%), had higher chest abbreviated injury scale (AIS 2.8 ± 0.6 vs. 2.2 ± 0.5) and Injury Severity Score ( ISS 17.5 ± 8.6 vs. 13.3 ± 9.6), were more likely to be intubated (33% vs. 19%), required chest tube insertion (13.4% vs. 4.3%), and received blood transfusion (29% vs. 17%). Rates of spine fracture, head injury, and solid organ injury were comparable in the two groups. Manubrium, clavicular and scapular fractures, lung contusion, hemothorax, and pneumothorax were significantly more evident in those who had rib fractures. Hospital length of stay was prolonged in patients with rib fractures (P = 0.008). The overall mortality was higher but not statistically significant in patients with rib fractures (5.0% vs. 3.2%).

Conclusions:

Sternal fractures are rare, and detection of associated injuries requires a high index of suspicion. Combined sternal and rib fractures are more evident in relatively older patients after chest trauma. This combination has certain clinical implications that necessitate further prospective studies.

Beneficial effects of percutaneous minimally invasive surgery for patients with fractures in the thoracic spine

Percutaneous minimally invasive surgery (PMIS) is the most common surgical procedure used in patients with fractures in the thoracic spine. In the present study, the benefits of PMIS compared with the conventional open surgery (COS) were investigated in patients with thoracic spine fractures. A total of 84 patients were recruited in the current analysis. Inflammatory responses were measured in all patients subsequent to PMIS and COS. It was demonstrated that PMIS produced reduced inflammatory responses as compared with COS in clinical patients. In addition, the results revealed that kyphosis, anterolisthesis and the neurological state were significantly improved in patients subjected to PMIS compared with those receiving COS (P<0.01). The mean values of bone reduction and fracture correction loss were similar in the PMIS and COS groups (4.5 degrees). Furthermore, the outcomes indicated that the sensitivity for fracture localization to the correct vertebra was 0.90 in PMIS and 0.92 in COS (P>0.05). It was observed that patients who had undergone PMIS required reduced hospitalization time compared with the COS-treated patients (P=0.026). Additionally, the mean bleeding volume during surgery was 538 ml in the PMIS patients and 845 ml in the COS patients. Regarding physical activity, patients who underwent PMIS were relative more active compared with the COS patients (P=0.038) in a 14-day observation. In conclusion, the current clinical analysis indicated that PMIS was more beneficial for the treatment of patients with fractures in the thoracic spine, and the study provided further evidence for the management thoracic spine injuries.

Efficacy of Pedicle Screw Fixation in Unstable Upper and Middle Thoracic Spine Fractures

BACKGROUND

Treatment of unstable upper and middle thoracic spine fractures remains controversial. There is no consensus regarding optimal treatment.

OBJECTIVES

In this study, we evaluated the efficacy of pedicular screw in the management of middle thoracic spine fractures to correct kyphosis and anterolisthesis and improve neurologic condition of patients.

PATIENTS AND METHODS

Twenty-five patients with unstable T1-T10 fractures treated with pedicle screw fixation technique were studied. Neurologic situation, preoperative and postoperative radiographs were evaluated. Radiographic measurements included kyphotic deformity and anterolisthesis. An American Spinal Injury Association (ASIA) scale was used for neurologic classification of the patients.

RESULTS

From a total of 25 patients, 21 cases were male and 4 were female. The mean age of the patients was 35.40 ± 14.39 years. The mean degree of kyphosis improved from 27.04 ± 7.33 degrees preoperatively to 15.96 ± 5.76 degrees at final follow-up. The mean of anterolisthesis improved from 6.44 ± 4.93 mm to 0.96 ± 0.36 mm at final follow-up. Kyphosis (P = 0.0001), anterolisthesis (P = 0.0001) and neurological state (P = 0.01) improved significantly after operation. No cases of hardware failure, neurological deterioration and loss of correction were reported.

CONCLUSIONS

Application of pedicular screw in unstable upper and middle thoracic spine fractures is an effective method that can correct kyphotic deformity and anterolisthesis and improve neurologic deficit.

Location of sternal fractures as a possible marker for associated injuries

Introduction. Sternal fractures often occur together with serious and life-threatening additional injuries. This retrospective study was designed to assess concomitant injuries and develop a correlation between fracture location and the severity of injury. Methods. All patients (n = 58) diagnosed with a fracture of the sternum by means of a CT scan were analysed with respect to accident circumstances, fracture morphology and topography, associated injuries, and outcome. Results. Isolated sternal fractures occurred in 9%. In all other admissions, concomitant injuries were diagnosed: mainly rip fractures (64%), injury to the head (48%), the thoracic spine (38%), lumbar spine (27%), and cervical spine (22%). Predominant fracture location was the manubrium sterni. In these locations, the observed mean ISS was the highest. They were strongly associated with thoracic spine and other chest injuries. Furthermore, the incidence of head injuries was significantly higher. ICU admission was significantly higher in patients with manubrium sterni fractures. Conclusion. Sternal fractures are frequently associated with other injuries. It appears that the fracture location can provide important information regarding concomitant injuries. In particular, in fractures of manubrium sterni, the need for further detailed clinical and radiologic workup is necessary to detect the frequently associated injuries and reduce the increased mortality.

Can initial clinical assessment exclude thoracolumbar vertebral injury?

Introduction

The aim of this study was to test the hypothesis that all blunt trauma patients, presenting with a Glasgow coma scale (GCS) score of 15, without intoxication or neurological deficit, and no pain or tenderness on log-roll can have any thoracolumbar fracture excluded without imaging.

Materials and Methods

All patients diagnosed with a thoracolumbar fracture presenting to the emergency department of a major trauma centre and having an initial GCS score of 15 were included in the study. Variables collected included type of fracture, mechanism of injury, the presence of pain or tenderness on log-roll, ethanol levels and prehospital opioid analgesia.

Results

There were 536 patients with thoracolumbar fractures, of which 508 (94.8%) patients had either pain, tenderness or had received prehospital opioid analgesia. A small subgroup of 28 (5.2%) patients who received no prehospital opioid analgesia, did not complain of pain and had no tenderness to the thoracolumbar spine elicited on log-roll. This subgroup was significantly older (p=0.033) and a high proportion of patients (64.3%) had a concurrent fracture of the cervical spine. Within this subgroup, a clinically significant unstable thoracic fracture was present in three patients, with all three patients exhibiting symptoms and signs of neurological injury or having a concurrent cervical vertebral fracture.

Conclusions

In this population of blunt trauma patients with a GCS score of 15, not under the influence of alcohol or prehospital morphine administration, the absence of pain or tenderness on log-roll can exclude a clinically significant lumbar vertebral fracture, but does not exclude a thoracic fracture.

Thoracic spine injury after a high-speed motor vehicle crash

In late October, a hospital-based flight team was activated at 9:30 pm for an approximately 30-year-old man involved in a high-speed motor vehicle crash into a tree. Per emergency medical services (EMS) documentation, flight service was requested for advanced airway management and rapid transport of the patient to a Level 1 trauma center. Ground transport was estimated at 60+ minutes, whereas actual flight time was less than 15 minutes. On the crew's arrival at the designated landing zone, they were escorted to an ambulance where a 100-kg man was immobilized on a stretcher. Because the landing area was at a remote location, the flight team did not witness the scene; however, the ground paramedic reported that the patient was the single-occupant driver of a small sedan. Given the extent of damage to the front and passenger side of the vehicle, it was determined that the patient was driving at a high rate of speed when he struck the tree. He required approximately 20 to 25 minutes of extrication. An empty bottle of zolpidem (Ambien) was found on the floor of the vehicle; the 30-day prescription had been filled approximately a week before the accident occurred.