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Planchamp T, Rouch A, Vergé R, Brouchet L, Gurrera E, Fusi G, Sales de Gauzy J, Accadbled F, Abbo O, Calvaruso FD, Bolzinger M. Secondary manubriosternal joint dislocation displacement in a teenager patient. Trauma Surg Acute Care Open 2024; 9:e001259. [PMID: 39077749 PMCID: PMC11284927 DOI: 10.1136/tsaco-2023-001259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Affiliation(s)
| | - Axel Rouch
- Department of Thoracic surgery, Larrey Hospital, Toulouse, France
| | - Romain Vergé
- Department of Thoracic surgery, Larrey Hospital, Toulouse, France
| | - Laurent Brouchet
- Department of Thoracic surgery, Larrey Hospital, Toulouse, France
| | - Emmanuel Gurrera
- Department of Emergencies, Hôpital des Enfants - CHU Toulouse, Hôpital des Enfants, Toulouse, France
| | - Giulia Fusi
- Department of Paediatric Surgery, Hôpital des Enfants, Toulouse, France
| | | | - Franck Accadbled
- Department of Paediatric Surgery, Hôpital des Enfants, Toulouse, France
| | - Olivier Abbo
- Department of Paediatric Surgery, Hôpital des Enfants, Toulouse, France
| | - Felice Davide Calvaruso
- Department of Cardiac surgery, Hôpital Purpan, CHU Toulouse, Hôpital Purpan, Toulouse, France
| | - Manon Bolzinger
- Department of Paediatric Surgery, Hôpital des Enfants, Toulouse, France
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Bauman ZM, Todd SJ, Khan H, Raposo-Hadley A, Cantrell E, Matos M, Sheppard O, Kamien A, Daubert T, Cemaj S, Evans CH, Nguyen J, Berning B. Sternal fixation for traumatic sternal fractures demonstrates better long-term quality of life outcomes than nonoperative management: A survey analysis. World J Surg 2024; 48:1309-1314. [PMID: 38553827 DOI: 10.1002/wjs.12164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/17/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Sternal fractures are rare, causing significant pain, respiratory compromise, and decreased upper extremity range of motion. Sternal fixation (SF) is a viable treatment option; however, there remains a paucity of literature demonstrating long-term benefits. This study examined long-term outcomes of SF, hypothesizing they have better long-term quality of life (QoL) than patients managed nonoperatively (NOM). METHODS This was a survey study at our level 1 academic hospital. All patients diagnosed with a sternal fracture were included from January 2016 to July 2021. Patients were grouped whether they received SF or NOM. Basic demographics were obtained. Three survey phone call attempts were conducted. The time from injury to survey was recorded. Outcomes included responses to the QoL survey, which included mobility, self-care, usual activities, chest pain/discomfort, and anxiety/depression. The survey scale is 1-5 (1 = worst condition possible; 5 = best possible condition). Patients were asked to rate their current health on a scale of 0-100 (100 being the best possible health imaginable). Chi square and t-tests were used. Significance was set at p < 0.05. RESULTS Three hundred eighty four patients were surveyed. Sixty nine underwent SF and 315 were NOM. Thirty-eight (55.1%) SF patients and 126 (40%) NOM patients participated in the survey. Basic demographics were similar. Average days from sternal fracture to survey was 1198 (±492) for the SF group and 1454 (±567) for the NOM group. The SF cohort demonstrated statistically significant better QoL than the NOM cohort for all categories except anxiety/depression. CONCLUSION SF provides better long-term QoL and better overall health scores compared to NOM.
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Affiliation(s)
- Zachary M Bauman
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sydney J Todd
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Hason Khan
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ashley Raposo-Hadley
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Emily Cantrell
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Miguel Matos
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Olabisi Sheppard
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Andrew Kamien
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Trevor Daubert
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Samuel Cemaj
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Charity H Evans
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jonathan Nguyen
- Division of Acute Care Surgery, Department of Surgery, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Bennett Berning
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Alqazzaz A, Naseer Z, Beyer CA, Cannon JW, Khalsa A. Treatment approach for coexisting chest wall fractures and unstable thoracolumbar spine fractures in polytrauma patients requiring prone spine surgery. Trauma Surg Acute Care Open 2024; 9:e001196. [PMID: 38529315 PMCID: PMC10961491 DOI: 10.1136/tsaco-2023-001196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/31/2023] [Indexed: 03/27/2024] Open
Abstract
Concomitant chest wall fractures (sternal and/or rib fractures) with unstable thoracolumbar fractures that require surgical fixation are rare but highly morbid injuries that mandate a multidisciplinary approach to treatment. There is limited evidence in the literature regarding optimal timing and order of surgical fixation of these patients with multiple injuries. Here, we present our experience with two patients at a single institution that demonstrates the challenges that present with this patient population. We advocate for earlier fixation of the chest wall fractures in the appropriately indicated patients, prior to prone positioning for spinal fixation.
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Affiliation(s)
- Aymen Alqazzaz
- Department of Orthopaedics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Zan Naseer
- Department of Orthopaedics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Carl A Beyer
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jeremy W Cannon
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Amrit Khalsa
- Department of Orthopaedics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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4
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Torimitsu S, Nishida Y, Yajima D, Inokuchi G, Makino Y, Motomura A, Chiba F, Yamaguchi R, Hoshioka Y, Iwase H. Statistical analysis of biomechanical properties and size of the sternum and its fracture risk in a Japanese sample. Leg Med (Tokyo) 2023; 62:102242. [PMID: 36924618 DOI: 10.1016/j.legalmed.2023.102242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/07/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE Sternal fractures can have life-threatening complications. To understand chest injury mechanisms, sufficient data regarding the mechanical properties and structure of the sternum are required. The aim of this study was to examine the mechanical properties and size of the sternum in a Japanese forensic sample. MATERIALS AND METHODS Sterna were obtained from 120 Japanese dead bodies of known age and sex. The sample thickness (ST) and the sample width (SW) were measured using a computed tomographic image. Three-point-bending tests were conducted using a three-point-bending apparatus to assess the fracture load (FL) of the sample. Then, the flexural strength (FS) was calculated and the natural logarithm of FL (ln FL) and FS (ln FS) were also calculated. RESULTS The values of ST, ln FL, and ln FS for male samples were significantly greater than those for female samples. Both ln FL and ln FS had significant negative correlations with age regardless of sex; the Pearson product-moment correlation coefficients were larger for female samples than for male samples. Although age was significantly negatively correlated with SW in female samples, there was no significant correlation between age and SW in male samples. No significant correlations were found between age and ST regardless of sex. CONCLUSION This is the first study to present quantitative data on the biomechanical properties of the sternum. Because of the smaller sternal strength of elderly women, it is especially important for them to avoid the risk of sternal fractures.
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Affiliation(s)
- Suguru Torimitsu
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Yoshifumi Nishida
- Department of Mechanical Engineering, Tokyo Institute of Technology, 2-12-1, O-okayama, Meguro-ku, Tokyo 152-8552, Japan.
| | - Daisuke Yajima
- Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba 286-8686, Japan.
| | - Go Inokuchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Ayumi Motomura
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba 286-8686, Japan.
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Yumi Hoshioka
- Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
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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. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023:10.1007/s00590-023-03479-0. [PMID: 36735092 PMCID: PMC10368550 DOI: 10.1007/s00590-023-03479-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Sternal fractures (SF) are uncommon injuries usually associated with a significant mechanism of injury. Concomitant injury is likely, and a risk of mortality is substantial. AIM Our aim in this study was to identify the risk factors for mortality in patients who had sustained sternal fractures. METHODS We conducted a single centre retrospective review of the trust's Trauma Audit and Research Network Database, from May 2014 to July 2021. Our inclusion criteria were any patients who had sustained a sternal fracture. The regions of injury were defined using the Abbreviated Injury Score. Pearson Chi-Squared, Fisher Exact tests and multivariate regression analyses were performed using IBM SPSS. RESULTS A total of 249 patients were identified to have sustained a SF. There were 19 patients (7.63%) who had died. The most common concomitant injuries with SF were Rib fractures (56%), Lung Contusions (31.15%) and Haemothorax (21.88%). There was a significant increase in age (59.93 vs 70.06, p = .037) and admission troponin (36.34 vs. 100.50, p = .003) in those who died. There was a significantly lower GCS in those who died (10.05 vs. 14.01, p < .001). On multi regression analysis, bilateral rib injury (p = 0.037, OR 1.104) was the only nominal variable which showed significance in mortality. CONCLUSION Sternal Fractures are uncommon but serious injuries. Our review has identified that bilateral rib injuries, increase in age, low GCS, and high admission troponin in the context of SF, were associated with mortality.
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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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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] [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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7
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Spiegl UJ, Osterhoff G, Bula P, Hartmann F, Scheyerer MJ, Schnake KJ, Ullrich BW. Concomitant injuries in patients with thoracic vertebral body fractures-a systematic literature review. Arch Orthop Trauma Surg 2022; 142:1483-1490. [PMID: 33649914 PMCID: PMC7919626 DOI: 10.1007/s00402-021-03830-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/08/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to give a systematic overview over the rate and location of concomitant injuries, the probability of suffering from neurological deficits, and to give evidence of the timing of surgery in severely injured patients with unstable thoracic vertebral body fractures. METHODS This review is based on articles retrieved by a systematic search in the PubMed and Web of Science database for publications up to November 2020 dealing with unstable fractures of the mid-thoracic spine. RESULTS Altogether, 1109 articles were retrieved from the literature search. A total of 1095 articles were excluded. Thus, 16 remaining original articles were included in this systematic review depicting the topics timing of surgery in polytraumatized patients, outcome neurologic deficits, and impact of concomitant injuries. The overall level of evidence of the vast majority of studies is low. CONCLUSION The evidence of the available literature is low. The cited studies reveal that thoracic spinal fractures are associated with a high number of neurological deficits and concomitant injuries, particularly of the thoracic cage and the lung. Thereby, diagnostic algorithm should include computer tomography of the whole thoracic cage if there is any clinical sign of concomitant injuries. Patients with incomplete neurologic deficits benefit from early surgery consisting of decompression and long-segmental stabilization.
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Affiliation(s)
- Ulrich J. Spiegl
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Philipp Bula
- Department of Orthopaedics and Trauma Surgery, Klinikum Gütersloh, Gütersloh, Germany
| | - Frank Hartmann
- Center for Trauma and Orthopedic Surgery, Gemeinschaftsklinikum Mittelrhein, Ev. Stift, Koblenz, Germany
| | - Max J. Scheyerer
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Klaus J. Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus, St. Marien, Erlangen, Germany
| | - Bernhard W. Ullrich
- Department of Trauma Surgery and Reconstructive Surgery, BG Klinikum Bergmannstrost, Halle, Germany
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8
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Doyle JE, Diaz-Gutierrez I. Traumatic sternal fractures: a narrative review. MEDIASTINUM (HONG KONG, CHINA) 2021; 5:34. [PMID: 35118339 PMCID: PMC8794297 DOI: 10.21037/med-21-27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/03/2021] [Indexed: 06/14/2023]
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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9
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Timala RB, Panthee N. Sternal Fracture Fixation with a Steel Wire: The New “Timala” Technique. JOURNAL OF TRAUMA AND INJURY 2021. [DOI: 10.20408/jti.2021.0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose Traumatic sternal fractures are rare but quite disabling injuries. Timely fixation of sternal fractures reduces pain and prevents respiratory complications. However, the fixation technique should be simple, effective, and readily available in local circumstances. Methods From January 2014 to March 2020, seven patients with sternal fracture/ dislocation underwent steel wire fixation with the new “Timala” technique. In this technique, adjacent ribs are anchored with two steel wires to form an “X” in front of the fractured segment of the sternum. Patients were followed up clinically and radiologically. Results Six of the patients were men and one was a female. Five of them had injuries due to falls and two were injured in road traffic accidents. Their age ranged from 18 years to 76 years, with a median age of 41 years. All seven patients experienced immediate recovery from pain and showed evidence of fracture healing on postoperative chest X-rays and clinical examinations. Conclusions Anchoring ribs to fix the sternum with steel wire is a safe, effective, easily available, and reproducible method to fix sternal fractures or dislocations.
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10
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Klei DS, Öner FC, Leenen LPH, van Wessem KJP. Current treatment and outcomes of traumatic sternovertebral fractures: a systematic review. Eur J Trauma Emerg Surg 2021; 47:991-1001. [PMID: 33006034 PMCID: PMC8322016 DOI: 10.1007/s00068-020-01505-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Combined sternal and spinal fractures are rare traumatic injuries with significant risk of spinal and thoracic wall instability. Controversy remains with regard to treatment strategies and the biomechanical need for sternal fixation to achieve spinal healing. The present study aimed to assess outcomes of sternovertebral fracture treatment. METHODS A systematic review of literature on the treatment of traumatic sternovertebral fractures was conducted. Original studies published after 1990, reporting sternal and spinal healing or stability were included. Studies not reporting treatment outcomes were excluded. RESULTS Six studies were included in this review, with a total study population of 98 patients: 2 case series, 3 case reports, and 1 retrospective cohort study. 10 per cent of sternal fractures showed displacement. Most spinal fractures were located in the thoracic spine and were AOSpine type A (51%), type B (35%), or type C (14%). 14 per cent of sternal fractures and 49% of spinal fractures were surgically treated. Sternal treatment failure occurred in 5% of patients and biomechanical spinal failure in 8%. There were no differences in treatment failure between conservative and operative treatment. CONCLUSION Literature on traumatic sternovertebral fracture treatment is sparse. Findings indicate that in most patients, sternal fixation is not required to achieve sternal and spinal stability. However, results of the current review should be cautiously interpreted, since most included studies were of poor quality.
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Affiliation(s)
- Dorine S Klei
- Department of Trauma Surgery, Medical Centre Utrecht, University, Suite G04.232, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.
| | - F Cumhur Öner
- Orthopaedic Surgery, Department of Orthopaedic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Luke P H Leenen
- Department of Trauma Surgery, Medical Centre Utrecht, University, Suite G04.232, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Karlijn J P van Wessem
- Department of Trauma Surgery, Medical Centre Utrecht, University, Suite G04.232, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
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Klei DS, Öner FC, Leenen LPH, van Wessem KJP. No Need for Sternal Fixation in Traumatic Sternovertebral Fractures: Outcomes of a 10-Year Retrospective Cohort Study. Global Spine J 2021; 11:283-291. [PMID: 32875901 PMCID: PMC8013937 DOI: 10.1177/2192568220902413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Combined sternal and spinal fractures are rare traumatic injuries and present a high risk of spinal and thoracic wall instability. Limited research has addressed the treatment of sternovertebral injuries and biomechanical need for sternal fixation to achieve spinal healing. METHODS A 10-year retrospective cohort study was conducted, including patients with sternovertebral fractures admitted to our level-1 trauma centre between 2007 and 2016. Patients who died during hospital admission, military patients, patients with isolated upper cervical spine or lower lumbar spine fractures, and patients lost to follow-up were excluded. RESULTS In 10 years, 73 patients with sternovertebral fractures were included. Mean injury severity score was 24 (range 4-57). Most sternal fractures were located in the sternal body and manubrium. Spinal fractures were type A (52%), B (40%), or C (8%), and were located in the subaxial cervical (21%), upper thoracic (16%), thoracic (21%), thoracolumbar (47%) area; 7 patients had spinal fractures at multiple levels. Fourteen patients (19%) had a neurological deficit. A total of 42 patients received conservative and 31 patients received operative spinal treatment. Two patients (3%) underwent primary sternal fixation. Sternal failure rate was 1% and biomechanical spinal failure rate was 8%, there was no difference in treatment failure between surgical and conservative spinal treatment. Associated thoracic injuries did not influence sternal or spinal treatment outcomes. CONCLUSIONS These findings indicate that conservative sternal treatment in presence of spinal fractures is safe and effective. The low spinal treatment failure rates imply that sternal fixation is not necessary to achieve spinal stability.
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Affiliation(s)
- Dorine S. Klei
- Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - F. Cumhur Öner
- Department of Orthopedic Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Luke P. H. Leenen
- Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Karlijn J. P. van Wessem
- Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands,Karlijn J. P. van Wessem, Department of Trauma Surgery, University Medical Centre Utrecht, Suite G04.232, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
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12
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Bauman ZM, Yanala U, Waibel BH, Malhotra GK, Cemaj S, Evans CH, Schlitzkus LL. Sternal fixation for isolated traumatic sternal fractures improves pain and upper extremity range of motion. Eur J Trauma Emerg Surg 2021; 48:225-230. [PMID: 33388786 DOI: 10.1007/s00068-020-01568-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Sternal fractures are debilitating due to intractable pain, constant fracture movement and limited range of motion (ROM) of the upper extremities (UE). Traditional treatment comprises mainly of pain control, delaying return to daily activities. Recently, sternal fixation has gained popularity. There is, however, a lack of literature demonstrating efficacy. We report our experience of traumatically fractured sternal fixation. METHODS Following IRB approval, a retrospective chart review was completed for all patients undergoing sternal fixation by a single trauma surgeon at our Level I trauma center. Basic demographics were obtained. Primary outcomes included average cumulative pain scores, total cumulative narcotic amounts and total number of pain medication agents utilized prior to and after sternal fixation. Secondary outcome included physical therapy UE ROM before and after surgery. Paired t tests were used for comparison; significance set at p < 0.05. RESULTS Thirteen patients underwent sternal fixation from 8/2016 to 2/2018. Average age was 54.4 ± 20.8 years; 54% were female. All patients experienced blunt trauma; average injury severity score was 15.8 ± 10.9 and abbreviated chest injury score was 2.5 ± 0.51. Average intensive care unit/hospital length of stay was 2.3/10.2 days. Average pain scores significantly improved by a score of 3.5 postoperatively (preoperative = 7.08 ± 2.3, postoperative = 3.54 ± 2.5; p = 0.001). Total pain medications required by sternal fixation patients significantly decreased by 1 medication postoperatively (preoperative = 4.2 medications, postoperative = 3.2 medications; p = 0.002). Average narcotic requirements significantly decreased by 7.59 morphine milligram milliequivalents (MME) after sternal fixation (preoperative amount = 71.78 MME, postoperative amount = 64.19 MME; p = 0.041). Every patient had limited UE ROM preoperatively; however, all but one patient resumed full UE ROM postoperatively (p < 0.001). There were no postoperative complications. CONCLUSIONS Sternal fixation is a safe and effective procedure resulting in improved pain, decreased narcotic requirements, and faster recovery.
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Affiliation(s)
- Zachary M Bauman
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE, 68198-3280, USA.
| | - Ujwal Yanala
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE, 68198-3280, USA
| | - Brett H Waibel
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE, 68198-3280, USA
| | - Gautam K Malhotra
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE, 68198-3280, USA
| | - Samuel Cemaj
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE, 68198-3280, USA
| | - Charity H Evans
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE, 68198-3280, USA
| | - Lisa L Schlitzkus
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE, 68198-3280, USA
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13
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Comparison of surgical fixation and non-operative management in patients with traumatic sternum fracture. Eur J Trauma Emerg Surg 2020; 48:219-224. [PMID: 33078258 PMCID: PMC7571865 DOI: 10.1007/s00068-020-01527-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/09/2020] [Indexed: 11/12/2022]
Abstract
Purpose The incidence of sternal fractures in blunt trauma patients lies between 3 and 7%. The role, timing and indications for surgical management are not well delineated and remain controversial for patients undergoing surgical stabilization of sternum fracture (SSSF). We sought to identify the national rate of SSSF in patients with a sternum fracture hypothesizing patients undergoing SSSF will have a decreased rate of mortality and complications. Methods The Trauma Quality Improvement Program (2015–2016) was queried for patients with sternum fracture. Propensity scores were calculated to match patients undergoing SSSF to patients managed non-operatively in a 1:2 ratio using demographic data. Results From 9460 patients with a sternum fracture, 114 (1.2%) underwent SSSF. After propensity-matching, 112 SSSF patients were compared to 224 patients undergoing non-operative management (NOM). There were no differences in matched characteristics (all p > 0.05). Compared to patients undergoing NOM, patients undergoing SSSF had an increased median length of stay (LOS) (16 vs. 7 days, p < 0.001), ICU LOS (9.5 vs. 5.5 days, p = 0.016) and ventilator days (8 vs. 5, p = 0.035). The SSSF group had a similar rate of ARDS (2.7% vs. 2.2%, p = 0.80), pneumonia (1.8% vs. 0.9%, p = 0.48) and unplanned intubation (8.9% vs. 5.8%, p = 0.29) but a lower mortality rate (2.7% vs. 11.2%, p = 0.008). Conclusion Just over 1% of patients with sternum fracture underwent SSSF in a national analysis. Patients undergoing SSSF had an increased LOS and similar rate of all measured pulmonary complications, however a lower mortality rate compared to patients managed non-operatively.
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14
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Spiegl UJA, Schnake KJ, Hartmann F, Katscher S, Riehle M, Scheyerer MJ, Schmeiser G, Siekmann H, Osterhoff G. Traumatic Fractures of the Thoracic Spine. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:373-382. [PMID: 32392598 DOI: 10.1055/a-1144-3846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The majority of traumatic vertebral fractures occur at the thoracolumbar junction and the lumbar spine and less commonly at the mid-thoracic and upper thoracic spine. In accordance, a high number of articles are dealing with thoracolumbar fractures focusing on the thoracolumbar junction. Nonetheless, the biomechanics of the thoracic spine differ from the thoracolumbar junction and the lumbar vertebral spine. The aim of this review is to screen the literature dealing with acute traumatic thoracic vertebral fractures in patients with normal bone quality. Thereby, the diagnostic of thoracic vertebral body fractures should include a CT examination. Ideally, the CT should include the whole thoracic cage particularly in patients suffering high energy accidents or in those with clinical suspicion of concomitant thoracic injuries. Generally, concomitant thoracic injuries are frequently seen in patients with thoracic spine fractures. Particularly sternal fractures cause an increase in fracture instability. In case of doubt, long segment stabilization is recommended in patients with unstable mid- und upper thoracic fractures, particularly in those patients with a high grade of instability.
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Affiliation(s)
- Ulrich J A Spiegl
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital Leipzig
| | | | - Frank Hartmann
- Centre for Trauma and Orthopaedic Surgery, Ev. Stift St. Martin, Community Hospital Mittelrhein, Koblenz
| | | | - Marion Riehle
- Orthopaedic and Trauma Centre, Alb Fils Hospitals, Göppingen
| | - Max J Scheyerer
- Clinic and Outpatient Department for Orthopaedic and Trauma Surgery, Cologne University Hospital
| | | | | | - Georg Osterhoff
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital Leipzig
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15
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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] [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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16
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Schulz-Drost S, Ekkernkamp A, Stengel D. [Epidemiology, injury entities and treatment practice for chest wall injuries : Current scientific knowledge and treatment recommendations]. Unfallchirurg 2019; 121:605-614. [PMID: 30073550 DOI: 10.1007/s00113-018-0532-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fractures of the bony chest wall are common injuries. They affect almost every second severely injured person and are gaining more and more importance even after low-energy accidents, especially among older people. Complications mainly occur due to respiratory insufficiency, secondary pulmonary complications and remaining deformities with a functional disorder of the chest wall. In addition to the important conservative therapeutic measures, such as a differentiated pain therapy and pneumonia prophylaxis, operative stabilization of fractures can be an option; however, this is still controversially discussed. OBJECTIVE A thematically structured overview provides basic knowledge on rib and sternal fractures as well as the treatment options. MATERIAL AND METHODS Epidemiological facts are presented based on the relevant literature and clinical experience. Anatomical principles are intended to improve understanding of the various entities of rib and sternal fractures. For this purpose, the new AO‑/OTA classification system is presented and finally therapeutic options including different osteosynthesis procedures are presented and their importance discussed. RESULTS AND DISCUSSION Multimodal therapy concepts and closely controlled follow-up examinations of fractures avoid complications or can detect them early. Bony chest wall injuries should still be evaluated for complications and typical fracture patterns identified and classified. Modern osteosynthesis procedures with high patient safety and soft tissue-preserving tissue preparation for the surgical access route to the ribs and sternum provide an excellent opportunity for successful restoration of the anatomical and physiological integrity of the bony thorax.
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Affiliation(s)
- S Schulz-Drost
- Klinik für Unfallchirurgie und Orthopädie, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Deutschland.
| | - A Ekkernkamp
- Klinik für Unfallchirurgie und Orthopädie, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Deutschland
| | - D Stengel
- Klinik für Unfallchirurgie und Orthopädie, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Deutschland
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17
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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. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 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] [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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18
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Krinner S, Langenbach A, Hennig FF, Ekkernkamp A, Schulz-Drost S. [Lesions of the anterior chest wall-significance of additional fractures of the spine]. Unfallchirurg 2018; 121:624-633. [PMID: 30043075 DOI: 10.1007/s00113-018-0529-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fractures of the anterior chest wall are rare among the total number of fractures. They include sternal fractures (SF) and the adjacent cartilaginous structures of the ribs. The accident mechanism can allow conclusions to be drawn about which further accompanying injuries may be present, e.g. rib and spinal fractures. OBJECTIVE The present work is intended to give an overview of injuries of the anterior chest wall. It includes clinical aspects as well as imaging and popular literature. MATERIAL AND METHODS Included are injury constellations of the anterolateral chest wall, in particular of the sternum in combination with injuries of the spinal column in the sense of a sternovertebral injury (SVI). Possible treatment strategies were reviewed and the corresponding advantages and disadvantages are presented. RESULTS In symptomatic fractures of the anterior chest wall, their operative stabilization should be considered in order to restore the stability of the trunk. In addition, rib fractures in direct trauma and spinal injuries in indirect trauma are often included in the treatment. CONCLUSION In the case of injuries of the thoracic trunk, this must always be regarded as a unit and must therefore be clarified in the context of the clinical examination and diagnostic apparatus. The possible accident mechanism can allow conclusions to be drawn about possible injury patterns, e.g. in the sense of SVIs.
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Affiliation(s)
- S Krinner
- Unfallchirurgische Abteilung, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland.
| | - A Langenbach
- Unfallchirurgische Abteilung, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - F F Hennig
- Unfallchirurgische Abteilung, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - A Ekkernkamp
- Klinik für Unfallchirurgie und Orthopädie, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warenerstr. 7, 12683, Berlin, Deutschland
| | - S Schulz-Drost
- Unfallchirurgische Abteilung, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland.,Klinik für Unfallchirurgie und Orthopädie, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warenerstr. 7, 12683, Berlin, Deutschland
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Current treatment and outcomes of traumatic sternal fractures-a systematic review. INTERNATIONAL ORTHOPAEDICS 2018; 43:1455-1464. [PMID: 29700586 PMCID: PMC6525114 DOI: 10.1007/s00264-018-3945-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 04/13/2018] [Indexed: 11/04/2022]
Abstract
Purpose Traumatic sternal fractures are rare injuries. The most common mechanism of injury is direct blunt trauma to the anterior chest wall. Most (> 95%) sternal fractures are treated conservatively. Surgical fixation is indicated in case of fracture instability, displacement or non-union. However, limited research has been performed on treatment outcomes. This study aimed to provide an overview of the current treatment practices and outcomes of traumatic sternal fractures and dislocations. Methods A systematic review of literature published from 1990 to June 2017 was conducted. Original studies on traumatic sternal fractures, reporting sternal healing or sternal stability were included. Studies on non-traumatic sternal fractures or not reporting sternal healing outcomes, as well as case reports (n = 1), were excluded. Results Sixteen studies were included in this review, which reported treatment outcomes for 191 patients. Most included studies were case series of poor quality. All patients showed sternal healing and 98% reported pain relief. Treatment complications occurred in 2% of patients. Conclusions Treatment of traumatic sternal fractures and dislocations is an underexposed topic. Although all patients in this review displayed sternal healing, results should be interpreted with caution since most included studies were of poor quality.
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20
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Schulz-Drost S, Krinner S, Oppel P, Grupp S, Schulz-Drost M, Hennig FF, Langenbach A. Fractures of the manubrium sterni: treatment options and a possible classification of different types of fractures. J Thorac Dis 2018; 10:1394-1405. [PMID: 29707289 DOI: 10.21037/jtd.2018.03.40] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Sternum fractures are mostly located on the sternal corpus, seldom on the manubrium. Fractures of the sternal manubrium are, however, more frequently associated with severe concomitant injuries of thoracic organs, and therefore deserve special attention. In addition, in its function as a capstone in between the anterior chest wall and the shoulder girdle, it is exposed to a multiplicity of forces. Therefore the questions arise what types of fractures are observed in today's clinical practice, how to classify them and which treatment options are available. This study reports on different types of fractures which involve the manubrium sterni. Methods Between January 2012 and October 2014, data was collected from all severely injured patients (ISS ≥16), which received a CT scan of the thorax in our Level-I-Trauma Center and retrospectively analyzed concerning sternal fractures. Fracture type, collateral injuries, age, and information about the circumstances of the accident were noted. Results Of 890 evaluable patients, 154 (17.3%) had a fracture of the sternum and 23 (2.6%) of the manubrium. Fractures of the manubrium appeared in following types: A-type-transverse fracture (n=11) in 1st intercostal space by direct blunt trauma or flexion of the torso with sagittal instability; B-type-oblique fracture (n=9) by seat belt injury with rotatory instability; C-type-combined, more fragmentary fracture (n=3) by direct blunt trauma with simultaneous flexion of the torso and multi directional instability. Fractures only little dislocation were treated conservatively, and unstable fractures were surgically stabilized (n=10). Conclusions In summary, three main types of fractures could be found. A-type fractures were stabilized with a longitudinal plate osteosynthesis and B-type fractures with transverse positioned plates. To treat complex C-type fractures, plates with a T- or H-form could be a good solution. Level of evidence: Level III retrospective prognostic cohort study.
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Affiliation(s)
- Stefan Schulz-Drost
- Department of Orthopedic and Trauma Surgery, University Hospital of Erlangen, Erlangen, Germany.,Department of Trauma and Orthopedic Surgery, BG Hospital Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Sebastian Krinner
- Department of Orthopedic and Trauma Surgery, University Hospital of Erlangen, Erlangen, Germany
| | - Pascal Oppel
- Department of Orthopedic and Trauma Surgery, University Hospital of Erlangen, Erlangen, Germany
| | - Sina Grupp
- Department of Orthopedic and Trauma Surgery, University Hospital of Erlangen, Erlangen, Germany
| | - Melanie Schulz-Drost
- Department of Medical Controlling and Management, Military Hospital, Berlin, Germany
| | - Friedrich F Hennig
- Department of Orthopedic and Trauma Surgery, University Hospital of Erlangen, Erlangen, Germany
| | - Andreas Langenbach
- Department of Orthopedic and Trauma Surgery, University Hospital of Erlangen, Erlangen, Germany
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21
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[Frequency and age distribution of combined sternovertebral injuries : Analysis of routine data from German hospitals 2005-2012]. Unfallchirurg 2018; 121:642-648. [PMID: 29404636 DOI: 10.1007/s00113-018-0460-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Combinations of sternal and spinal fractures often occur due to high velocity accidents and are associated with a high incidence of concomitant injuries. The anterior thoracic wall is described as the fourth column of torso stability, which is why sternovertebral injuries (SVI) present a high risk of sagittal deformation of the trunk, in particular injuries of the thoracic spine. To date, no studies have been published on the frequency distribution of the involved vertebral bodies in large patient groups. OBJECTIVES This study was intended to elaborate a frequency distribution of vertebral fractures accompanying sternal fractures (SF) and examine the risk of a vertebral fracture accompanying a SF. MATERIAL AND METHODS A total of 48,193 cases with the main or secondary diagnosis of a SF and 897,963 cases with vertebral fractures based on routine data of German hospitals from the years 2005-2012 were evaluated. A concomitant injury to the spinal column was examined for each vertebral body and then evaluated statistically. RESULTS AND CONCLUSIONS Of all patients with a SF 30.96% also suffered from a vertebral fracture. Of these 3.11% were SF as the main diagnosis and 60.89% the secondary diagnosis. While vertebral fractures generally occurred most frequently in the region of the thoracolumbar transition and the second cervical vertebral body, the SVI showed a further frequency peak in the range from the lower cervical spine to the middle thoracic spine. The present study was able to show a frequency distribution of accompanying vertebral body injuries in a large and representative collective in the case of SF for the first time.
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