1
|
Wada H, Yoshida S, Tamura H, Kamata T, Onozato Y, Karita R, Yoshino I. [Experience with Surgical Stabilization for Traumatic Rib Fractures and Sternal Fractures]. Kyobu Geka 2024; 77:288-293. [PMID: 38644177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
The treatment of traumatic rib fractures and sternal fractures have focused on pain and respiratory management, and conservative treatment has been recommended. Recently, however, a number of case series from abroad have been reported and demonstrated the usefulness of surgical stabilization of rib fractures (SSRF) and sternal fractures (SSSF). We have experienced seven cases of SSRF and two cases of SSSF at International University Health and Welfare Narita Hospital and Atami Hospital. Based on our experienced cases, we have outlined the preoperative evaluation, indication for surgery, timing of surgery, surgical techniques, and postoperative course. Of these nine cases, the clinical course of two cases of SSRF and one case of SSSF were detailly presented. The surgical indications and techniques for traumatic rib fractures and sternal fractures vary from institution to institution, and there is no single optimal treatment. We hope that the accumulation of cases, and discussions will help to build a higher quality evidence for surgical treatment of thoracic trauma in Japan.
Collapse
Affiliation(s)
- Hironobu Wada
- Department of Thoracic Surgery, International University Health and Welfare, Narita, Japan
| | | | | | | | | | | | | |
Collapse
|
2
|
Aldakheel DA. Classification of thoracic spine fractures: the four-column theory. Int Orthop 2023; 47:2907-2915. [PMID: 36943457 PMCID: PMC10673741 DOI: 10.1007/s00264-023-05778-x] [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] [Received: 01/31/2023] [Accepted: 03/11/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE The purpose of this study is to present a classification of thoracic spine fractures based on anatomical and biomechanical characteristics. METHODS This is a narrative review of the literature. RESULTS The classification is based on the relationship between movement and common forces acting on the spine. A mechanistic concept is incorporated into the classification, which considers both movements and the application of forces, leading to pathomorphological characteristics. A hierarchical ranking determines the severity of fractures within the thoracic spine, and treatment recommendations are presented in each category. The fourth column of the spine is incorporated into the classification through direct and indirect mechanisms. CONCLUSIONS The proposed classification accommodates several advantages, such as simplicity and practicality, that make this classification helpful in daily practice. The dynamic relationship between movement and force provides a better understanding of the fracture mechanism. Finally, incorporating the fourth column will strengthen the indication for surgical management. To the best of our knowledge, this classification is the first classification developed uniquely for the thoracic spine fractures and will help to address a critical gap in the literature.
Collapse
Affiliation(s)
- Dakheel A Aldakheel
- Colleg of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
- Department of Orthopaedic Surgery, King Fahd Hospital of the University, Khobar, Saudi Arabia.
| |
Collapse
|
3
|
Jones JC, White EE, Holladay SD, Foster JL. Anatomy of the sternum and humerus in the domestic chicken (Gallus domesticus). Vet Radiol Ultrasound 2023; 64:1037-1043. [PMID: 37927214 DOI: 10.1111/vru.13312] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/10/2023] [Accepted: 10/08/2023] [Indexed: 11/07/2023] Open
Abstract
Injuries of the sternum and humerus are an important welfare concern in domestic chickens (Gallus domesticus), especially laying hens. Published anatomic references using standardized terminology from the Nomina Anatomica Avium (NAA) are lacking. Objectives of the current retrospective, descriptive study were to provide a user-friendly hierarchical table of NAA-compliant anatomic terms and labeled images illustrating anatomic structures for the sternum and humerus of domestic chickens. Three-dimensional model images were downloaded from a publicly accessible platform, labeled in consultation with a veterinary anatomist, and enhanced by a medical illustrator. Findings can serve as a resource for future clinical and research applications.
Collapse
Affiliation(s)
- Jeryl C Jones
- Department of Animal and Veterinary Sciences, Clemson University, Clemson, South Carolina, USA
- South Carolina Translational Research Improving Musculoskeletal Health Center, Clemson University, Clemson, South Carolina, USA
| | - Emma E White
- Department of Animal and Veterinary Sciences, Clemson University, Clemson, South Carolina, USA
| | - Steven D Holladay
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Jenna L Foster
- Educational Resource Center, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| |
Collapse
|
4
|
Rochus I, Daemen JHT, van Vugt R, Hulsewé KWE, Vissers YLJ, de Loos ER. Delayed presentation of manubriosternal dislocation after thoracolumbar spondylodesis in a polytrauma patient - a case report. Acta Chir Belg 2023; 123:559-562. [PMID: 35369855 DOI: 10.1080/00015458.2022.2061120] [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] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/28/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Manubriosternal dislocations are a rare entity and frequently associated with thoracic spine fractures and, in minority of cases, with cervical or thoracolumbar fractures. METHODS Our case represents a 38-year-old male who fell from a height resulting in multiple fractures, amongst others of the first lumbar vertebra. At primary survey and computed tomography scan no manubriosternal injury was apparent. After posterior stabilization of the thoracolumbar vertebrae a manubriosternal dislocation was identified and stabilized using plate-and-screw fixation. RESULTS Clinical findings of a manubriosternal dislocation are not always obvious, allowing them to be missed at initial assessment. CONCLUSIONS Manubriosternal dislocations can be missed at the initial investigation, even on cross-sectional imaging, and only become visible after spine stabilization because of the tight relationship between sternum and vertebrae in the thoracic cage. There is no unanimity in literature for surgical treatment of manubriosternal dislocations, although plate fixation is generally considered a safe and effective treatment option.
Collapse
Affiliation(s)
- Ine Rochus
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Jean H T Daemen
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Raoul van Vugt
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Karel W E Hulsewé
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Erik R de Loos
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| |
Collapse
|
5
|
Demir Benli M. Stress fracture of the manubrium sterni during parallel bar dips. PHYSICIAN SPORTSMED 2023; 51:492-496. [PMID: 36877125 DOI: 10.1080/00913847.2023.2188047] [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: 10/04/2022] [Accepted: 03/03/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Stress fractures are common in highly active people, such as athletes or those in the military. They occur frequently in the lower extremities but sternal stress fractures are rare injuries. METHODS We present a case of a young male who reported no pain and a 'click' sound from the front of the chest while training with parallel bar dips with a grip that was wider than shoulder-width apart. RESULTS In this case, radiological evaluation was the most helpful tool to diagnose manubrium sterni stress fracture. We advised him to rest but he started exercises immediately because he had to participate in a military camp after the injury. The patient was treated conservatively. The treatment consisted of activity modification and supplemental drugs. CONCLUSION We report a case of manubrium stress fracture that developed in a young male military recruit.
Collapse
Affiliation(s)
- Merve Demir Benli
- Department of Sports Medicine, Izmir Katip Celebi University, Atatürk Education and Research Hospital, Izmır, Turkey
| |
Collapse
|
6
|
Del Rey de Cabo C, López Herrero R, Fernández Collantes A, Cocho Crespo S. Displaced sternal fracture and right internal thoracic artery injury induced by blunt chest trauma from cow kick. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:613-614. [PMID: 36220730 DOI: 10.1016/j.redare.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 11/11/2021] [Indexed: 06/16/2023]
Affiliation(s)
- C Del Rey de Cabo
- Servicio de Anestesiología y Reanimación, Hospital Virgen de la Concha, Zamora, Spain.
| | - R López Herrero
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A Fernández Collantes
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - S Cocho Crespo
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| |
Collapse
|
7
|
Kara H, Bayir A, Degirmenci S, Yildiran H, Kafali ME, Ak A. Sternal Fractures in Blunt Chest Trauma: Retrospective Analysis of 330 Cases. J Coll Physicians Surg Pak 2022; 32:799-803. [PMID: 35686415 DOI: 10.29271/jcpsp.2022.06.799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/05/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To analyse the range of injuries associated with sternal fracture (SF) and their clinical features and outcomes. STUDY DESIGN Observational study. PLACE AND DURATION OF STUDY Department of Emergency Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey, from July 2010 to July 2020. METHODOLOGY Sternal fractures were considered in 330 patients with blunt trauma during the study period. They were categorised according to the Johnson and Branfoot classification and the Arbeitsgemeinschaft fur Osteosynthesefragen / Orthopaedic Trauma Association classification. Demographic data were collected, including age, gender, mechanism of injury, associated injuries, and the length of hospital stay. RESULTS During the 10-year study period, a total of 4024 thoracic trauma patients were admitted to the emergency department. Of these, 330 (8.2%) had a sternal fracture. The median age of the patients was 41 (8-90) years, and 72.7% were male. Isolated sternal fractures occurred in 93 patients (28.2%). An additional thoracic injury was observed in 74 patients (22.4%) included in the study, and an accompanying extrathoracic injury was observed in 34 patients (10.3%). In 129 patients (39.1%), both thoracic and extrathoracic pathologies were detected, in addition to SF. The mortality rate among patients with isolated sternal fracture was 1.1%; the mortality rate among patients with sternal fracture accompanied by additional pathologies was 6.6%. CONCLUSION Sternal fractures are frequently associated with other injuries. Although isolated sternal fracture has a good prognosis, careful evaluation and clinical observation are essential for additional injuries. KEY WORDS Emergency medicine, Sternal fracture, Chest trauma.
Collapse
Affiliation(s)
- Hasan Kara
- Department of Emergency Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Aysegul Bayir
- Department of Emergency Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Selim Degirmenci
- Department of Emergency Medicine, Bilecik Training and Research Hospital, Bilecik, Turkey
| | - Huseyin Yildiran
- Department of Thoracic Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
| | | | - Ahmet Ak
- Department of Emergency Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey
| |
Collapse
|
8
|
Yavaş HG, Ufuk F, Akçay A, Öztürk G. The effect of skeletal muscle area and attenuation in patients with sternum fracture due to blunt chest trauma. Eur Rev Med Pharmacol Sci 2022; 26:1170-1177. [PMID: 35253173 DOI: 10.26355/eurrev_202202_28109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study aims to retrospectively investigate the imaging features of patients with sternum fracture (SF) and concomitant organ injuries. We also aimed to evaluate the potential prognostic effect of skeletal muscle area (TMA) and muscle attenuation (MuA) values. PATIENTS AND METHODS Computed tomography (CT) images of patients with SF were re-evaluated by two observers (Observer-1 and 2). Observer-3 has measured TMA and MuA values. Observer-1 has repeated the measurements blindly to the first measurement results to evaluate the inter-observer agreement. The length of hospital stay, death, hemiplegia, or quadriplegia were investigated from the archives. Mann-Whitney U-test or Student's t-test was used to investigate the relationship between linear variables. The intraclass correlation coefficient (ICC) score was used to evaluate the interobserver agreement. Logistic regression analysis was used to estimate the relative effect of variables by calculating unadjusted odds ratios (ORs) for categorical outcomes. RESULTS Sixty-five patients had SF and 53 patients had SF and concomitant organ injuries. The most common injuries accompanying SF were rib fracture (73.58%) and lung contusion (60.38%). Manubrium fracture was the most common fracture location (52.3%), and 18 patients (27.7%) had displaced SF. Eight patients (15.1%) were discharged with plegia and five (9.4%) died. Hemothorax, displaced SF and decreased MuA were predictors of prolonged hospital stay, and the presence of cardiac contusion, displaced SF, hemothorax, and vertebra body fracture were independent factors for death. CONCLUSIONS The presence of a displaced SF and decreased MuA value are important prognostic factors in patients with SF.
Collapse
Affiliation(s)
- H G Yavaş
- Department of Radiology, Kırşehir Education and Research Hospital, Kırşehir, Turkey.
| | | | | | | |
Collapse
|
9
|
Curtis K, Kourouche S, Asha S, Considine J, Fry M, Middleton S, Mitchell R, Munroe B, Shaban RZ, D’Amato A, Skinner C, Wiseman G, Buckley T. Impact of a care bundle for patients with blunt chest injury (ChIP): A multicentre controlled implementation evaluation. PLoS One 2021; 16:e0256027. [PMID: 34618825 PMCID: PMC8496821 DOI: 10.1371/journal.pone.0256027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/28/2021] [Indexed: 12/03/2022] Open
Abstract
Background Blunt chest injury leads to significant morbidity and mortality. The aim of this study was to evaluate the effect of a multidisciplinary chest injury care bundle (ChIP) on patient and health service outcomes. ChIP provides guidance in three key pillars of care for blunt chest injury—respiratory support, analgesia and complication prevention. ChIP was implemented using a multi-faceted implementation plan developed using the Behaviour Change Wheel. Methods This controlled pre-and post-test study (two intervention and two non-intervention sites) was conducted from July 2015 to June 2019. The primary outcome measures were unplanned Intensive Care Unit (ICU) admissions, non-invasive ventilation use and mortality. Results There were 1790 patients included. The intervention sites had a 58% decrease in non-invasive ventilation use in the post- period compared to the pre-period (95% CI 0.18–0.96). ChIP was associated with 90% decreased odds of unplanned ICU admissions (95% CI 0.04–0.29) at the intervention sites compared to the control groups in the post- period. There was no significant change in mortality. There were higher odds of health service team reviews (surgical OR 6.6 (95% CI 4.61–9.45), physiotherapy OR 2.17 (95% CI 1.52–3.11), ICU doctor OR 6.13 (95% CI 3.94–9.55), ICU liaison OR 55.75 (95% CI 17.48–177.75), pain team OR 8.15 (95% CI 5.52 –-12.03), analgesia (e.g. patient controlled analgesia OR 2.6 (95% CI 1.64–3.94) and regional analgesia OR 8.8 (95% CI 3.39–22.79), incentive spirometry OR 8.3 (95% CI 4.49–15.37) and, high flow nasal oxygen OR 22.1 (95% CI 12.43–39.2) in the intervention group compared to the control group in the post- period. Conclusion The implementation of a chest injury care bundle using behaviour change theory was associated with a sustained improvement in evidence-based practice resulting in reduced unplanned ICU admissions and non-invasive ventilation requirement. Trial registration ANZCTR: ACTRN12618001548224, approved 17/09/2018
Collapse
Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
- * E-mail:
| | - Sarah Kourouche
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Stephen Asha
- Emergency Department, St George Hospital, Kogarah, NSW, Australia
- St George Clinical School, Faculty of Medicine, University of New South Wales, Kogarah, NSW, Australia
| | - Julie Considine
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Experience in the Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety Experience–Eastern Health Partnership, Box Hill, VIC, Australia
| | - Margaret Fry
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
- Northern Sydney Local Health District, Hornsby, NSW, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne, Fitzroy, Australia
- Australian Catholic University, Sydney, NSW, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Belinda Munroe
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW, Australia
| | - Ramon Z. Shaban
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Camperdown, NSW, Australia
- Division of Infectious Diseases and Sexual Health, Department of Infection Prevention and Control, Westmead Hospital and Western Sydney Local Health District, Westmead, NSW, Australia
- New South Wales Biocontainment Centre, Western Sydney Local Health District and New South Wales Health, Warwick Farm, NSW, Australia
| | - Alfa D’Amato
- NSW Activity Based Funding Taskforce, NSW Ministry of Health, Sydney, Australia
| | - Clare Skinner
- Emergency Department, Hornsby Ku-ring-ai Hospital, Hornsby, NSW, Australia
| | - Glen Wiseman
- Emergency Services, Canterbury Hospital, Campsie, NSW, Australia
| | - Thomas Buckley
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
10
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
11
|
Abstract
ABSTRACT Sternal fractures have often been associated with high-impact thoracic trauma. In children, this is not always the case. X-ray and even computed tomography can miss subtle sternal fractures. Point-of-care ultrasound has been shown to be more sensitive and specific for detecting subtle sternal fractures as compared with plain X-ray. The following 2 cases describe sternal fractures that were missed by traditional imaging modalities, including a fracture missed by chest computed tomography. They also highlight other potential causative mechanisms for sternal fractures in children, including hyperflexion injuries and low-mechanism motor vehicle accidents.
Collapse
Affiliation(s)
- Paul Adeeb Khalil
- From the Denver Health Medical Center, University of Colorado, Aurora, CO
| | | | | |
Collapse
|
12
|
Toscano MJ, Dunn IC, Christensen JP, Petow S, Kittelsen K, Ulrich R. Explanations for keel bone fractures in laying hens: are there explanations in addition to elevated egg production? Poult Sci 2020; 99:4183-4194. [PMID: 32867962 PMCID: PMC7597989 DOI: 10.1016/j.psj.2020.05.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/29/2020] [Accepted: 05/23/2020] [Indexed: 12/15/2022] Open
Abstract
The current article served to provide the most up-to-date information regarding the causes of keel bone fracture. Although elevated and sustained egg production is likely a major contributing factor toward fractures, new information resulting from the development of novel methodologies suggests complementary causes that should be investigated. We identified 4 broad areas that could explain variation and increased fractures independent of or complementing elevated and sustained egg production: the age at first egg, late ossification of the keel, predisposing bone diseases, and inactivity leading to poor bone health. We also specified several topics that future research should target, which include continued efforts to link egg production and bone health, examination of noncommercial aves and traditional breeds, manipulating of age at first egg, a detailed histological and structural analysis of the keel, assessment of prefracture bone condition, and the relationship between individual activity patterns and bone health.
Collapse
Affiliation(s)
- Michael J Toscano
- Centre for Proper Housing of Poultry and Rabbits, VPHI Institute, Universität Bern, Zollikofen, 3052 Switzerland.
| | - Ian C Dunn
- The Roslin Institute, University of Edinburgh, EH25 9RG Scotland, United Kingdom
| | - Jens-Peter Christensen
- University of Copenhagen, Department of Veterinary & Animal Sciences, 1870 Frederiksberg C, Denmark
| | - Stefanie Petow
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health,Celle, Germany
| | - Kathe Kittelsen
- Animalia- the Norwegian Meat and Poultry Research Centre, N-0513 Oslo, Norway
| | - Reiner Ulrich
- Leipzig University, Faculty of Veterinary Medicine, Institute of Veterinary Pathology, 04103 Leipzig, Germany
| |
Collapse
|
13
|
Jang SJ, Cha YK, Kim JS, Do HH, Bak SH, Kwack WG. Computed tomographic findings of chest injuries following cardiopulmonary resuscitation: More complications for prolonged chest compressions? Medicine (Baltimore) 2020; 99:e21685. [PMID: 32872040 PMCID: PMC7437829 DOI: 10.1097/md.0000000000021685] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Chest injuries are common and inevitable complications of chest compressions during cardiopulmonary resuscitation (CPR). This study aimed to investigate lung parenchymal and thoracic skeletal injuries after CPR by using computed tomography (CT) and to analyze the correlation between the duration of CPR and related complications.We examined 43 non-traumatic cardiac arrest patients who were successfully resuscitated after CPR and had chest CT scans within 24 hours of CPR. Lung parenchymal injuries were assessed by quantifying the lung contusion score (LCS) on the CT images, and each skeletal injury was investigated by classifying the location and the distribution. Other CPR-related chest injuries were also described, such as pleural effusion/hemothorax, pneumothorax, and retrosternal hematoma. Statistical analysis was conducted to determine whether the duration of CPR was correlated with each complication.Lung contusions were found in all of the patients (mean LCS: 22, range: 5-47). The distribution of lung contusions were predominantly in the bilateral dependent portions of the lungs (41 patients). All of the rib fractures occurred in the anterior arc (43 patients), and the sternal fractures occurred predominantly in the mid-sternal body (31 patients). In patients younger than 70 years old, the number of rib fractures significantly increased among those who underwent CPR for more than 25 minutes compared to those who received CPR for less than 25 minutes (median 4.5 vs 9; mean 8.3 vs 5.6 per person, respectively; P = .035). The risk of sternal fracture tended to be higher for patients who received CPR for more than 10 minutes compared to those who received CPR for less than 10 minutes (odds ratio: 3.60; 95% confidence interval: 0.86-15.06; P = .079). However, there was no statistically significant correlation between the duration of CPR and LCS or other CPR-related chest injuries.The duration of CPR was associated with the number of rib fractures and the occurrence of sternal fractures, but it did not affect the extent of CPR-related lung contusions or other CPR-related chest injuries. All of the rib fractures occurred in the anterior arc, while the sternal fractures occurred predominantly in the mid-sternal body. However, since this study was conducted in a single institution, the number of patients included was relatively small, thus limiting the statistical analysis.
Collapse
Affiliation(s)
- Seo Jin Jang
- Department of Radiology, Dongguk University Ilsan Hospital, Dongguk University School of Medicine
| | - Yoon Ki Cha
- Department of Radiology, Dongguk University Ilsan Hospital, Dongguk University School of Medicine
| | - Jeung Sook Kim
- Department of Radiology, Dongguk University Ilsan Hospital, Dongguk University School of Medicine
| | - Han Ho Do
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Goyang
| | - So Hyeon Bak
- Department of Radiology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon
| | - Won Gun Kwack
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, South Korea
| |
Collapse
|
14
|
Armstrong EA, Rufener C, Toscano MJ, Eastham JE, Guy JH, Sandilands V, Boswell T, Smulders TV. Keel bone fractures induce a depressive-like state in laying hens. Sci Rep 2020; 10:3007. [PMID: 32080271 PMCID: PMC7033198 DOI: 10.1038/s41598-020-59940-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/03/2020] [Indexed: 02/06/2023] Open
Abstract
In commercial flocks of laying hens, keel bone fractures (KBFs) are prevalent and associated with behavioural indicators of pain. However, whether their impact is severe enough to induce a depressive-like state of chronic stress is unknown. As chronic stress downregulates adult hippocampal neurogenesis (AHN) in mammals and birds, we employ this measure as a neural biomarker of subjective welfare state. Radiographs obtained longitudinally from Lohmann Brown laying hens housed in a commercial multi-tier aviary were used to score the severity of naturally-occurring KBFs between the ages of 21-62 weeks. Individual birds' transitions between aviary zones were also recorded. Focal hens with severe KBFs at 3-4 weeks prior to sampling (n = 15) had lower densities of immature doublecortin-positive (DCX+) multipolar and bipolar neurons in the hippocampal formation than focal hens with minimal fractures (n = 9). KBF severity scores at this time also negatively predicted DCX+ cell numbers on an individual level, while hens that acquired fractures earlier in their lives had fewer DCX+ neurons in the caudal hippocampal formation. Activity levels 3-4 weeks prior to sampling were not associated with AHN. KBFs thus lead to a negative affective state lasting at least 3-4 weeks, and management steps to reduce their occurrence are likely to have significant welfare benefits.
Collapse
Affiliation(s)
- E A Armstrong
- Centre for Behaviour & Evolution, Newcastle University, Newcastle upon Tyne, UK.
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - C Rufener
- Department of Animal Science, University of California, Davis, USA
- Centre for Proper Housing: Poultry and Rabbits (ZTHZ), University of Bern, Zollikofen, Switzerland
| | - M J Toscano
- Centre for Proper Housing: Poultry and Rabbits (ZTHZ), University of Bern, Zollikofen, Switzerland
| | - J E Eastham
- Centre for Behaviour & Evolution, Newcastle University, Newcastle upon Tyne, UK
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - J H Guy
- Centre for Behaviour & Evolution, Newcastle University, Newcastle upon Tyne, UK
- School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - V Sandilands
- Department of Agriculture, Horticulture and Engineering Sciences, SRUC, Edinburgh, UK
| | - T Boswell
- Centre for Behaviour & Evolution, Newcastle University, Newcastle upon Tyne, UK
- School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - T V Smulders
- Centre for Behaviour & Evolution, Newcastle University, Newcastle upon Tyne, UK
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
15
|
Gorospe L, Casado JL, Serrano-Villar S, de la Puente-Bujidos C, Pérez-Elías MJ, Vivancos-Gallego MJ. Atraumatic Incomplete Sternal Fracture Incidentally Detected in a Human Immunodeficiency Virus Patient at Lung Cancer Screening With Low-Dose Thoracic CT. J Clin Rheumatol 2019; 25:e132. [PMID: 31764500 DOI: 10.1097/rhu.0000000000000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
16
|
Azeli Y, Barbería E, Jiménez-Herrera M, Ameijide A, Axelsson C, Bardaj A. Serious injuries secondary to cardiopulmonary resuscitation: incidence and associated factors. Emergencias 2019; 31:327-334. [PMID: 31625304] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To determine the incidence of serious rib cage damage (SRD) and serious visceral damage (SVD) secondary to cardiopulmonary resuscitation (CPR) and to explore associated factors. MATERIAL AND METHODS We analyzed data from the prospective registry of cases of sudden death in Tarragona, Spain (the ReCaPTa study). Cases were collected from multiple surveillance sources. In this study we included the cases of autopsied nonsurvivors after attempted manual CPR between April 2014 and May 2016. A specific protocol to detect injuries secondary to CPR was used during the autopsies. RESULTS We analyzed 109 cases. The mean age at death was 63 years and 32.1% were women. SRD were found in 63.3% and SVD in 14.7%. The group with SRD were significantly older (63 vs 59 years, P=.031) and included higher percentages of persons with a chest circumference over 101 cm (56.5 vs 30%, P=.016) and a waist circumference over 100 cm (62.3 vs 37.5%, P=.017). A multivariable analysis confirmed chest circumference over 101 cm as the only risk factor for SRD (odds ratio [OR], 2.45; 95% CI, 1.03-5.84) and female sex as the only risk factor for SVD (OR, 5.02; 95% CI, 1.18-21.25). CONCLUSION Women and any patient with a chest circumference greater than 101 cm are at greater risk for serious injuries related to CPR.
Collapse
Affiliation(s)
- Youcef Azeli
- Sistema d'Emergències Mèdiques de Catalunya, L'Hospitalet de Llobregat, Barcelona, España. Servicio de Urgencias, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, España. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, España
| | - Eneko Barbería
- Institut de Medicina Legal y Forense de Catalunya, Tarragona, España. Universitat Rovira i Virgili, Tarragona, España
| | | | - Alberto Ameijide
- Unidad de Bioestadística, Fundació Lliga per a la Investigació i Prevenció del Càncer, Reus, Tarragona, España
| | | | - Alfredo Bardaj
- Institut d'Investigació Sanitaria Pere Virgili, Tarragona, España. Universitat Rovira i Virgili, Tarragona, España. Servicio de Cardiología, Hospital Universitari Joan XXIII, Tarragona, España
| |
Collapse
|
17
|
Salerno S, Zerbo S, Vinci A, Lanzarone A, Baldino G, Procaccianti P, Lo Re G, Argo A. Role of post mortem computed tomography in diagnosis of upper cervical fractures in child due to road accident: A case report and literature review. Med Leg J 2019; 87:151-155. [PMID: 31295056 DOI: 10.1177/0025817219848285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Sergio Salerno
- Department of Diagnostic Radiology, Policlinico University of Palermo, Palermo, Italy
| | - Stefania Zerbo
- Section of Legal Medicine, Department of Health Promotion, University of Palermo, Palermo, Italy
| | - Alessia Vinci
- Department of Diagnostic Radiology, Policlinico University of Palermo, Palermo, Italy
| | - Antonietta Lanzarone
- Section of Legal Medicine, Department of Health Promotion, University of Palermo, Palermo, Italy
| | - Gennaro Baldino
- Section of Legal Medicine, Department of Health Promotion, University of Palermo, Palermo, Italy
| | - Paolo Procaccianti
- Section of Legal Medicine, Department of Health Promotion, University of Palermo, Palermo, Italy
| | - Giuseppe Lo Re
- Department of Diagnostic Radiology, Policlinico University of Palermo, Palermo, Italy
| | - Antonina Argo
- Section of Legal Medicine, Department of Health Promotion, University of Palermo, Palermo, Italy
| |
Collapse
|
18
|
Morf S. [CME: Significance of Thoracic Sonography in Thoracic Trauma]. Praxis (Bern 1994) 2018; 107:1243-1248. [PMID: 30424691 DOI: 10.1024/1661-8157/a003135] [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] [Indexed: 06/09/2023]
Abstract
CME: Significance of Thoracic Sonography in Thoracic Trauma Abstract. Trauma patients should be treated according to international guidelines. Depending on the severity of the trauma, an immediate threat to life must be ruled out and sonography is part of the complementation of diagnostics. The EFAST investigation includes the exclusion of fluid in the thorax, the exclusion of pneumothorax and the exclusion of fluid in the pericardium. Thorax ultrasound is becoming increasingly important in the evaluation of the outcome in thoracic trauma patients as well as in the control of the initiated therapy.
Collapse
Affiliation(s)
- Susanne Morf
- 1 Institut für klinische Notfallmedizin, Spital Limmattal
| |
Collapse
|
19
|
Toscano M, Booth F, Richards G, Brown S, Karcher D, Tarlton J. Modeling collisions in laying hens as a tool to identify causative factors for keel bone fractures and means to reduce their occurrence and severity. PLoS One 2018; 13:e0200025. [PMID: 29990363 PMCID: PMC6038993 DOI: 10.1371/journal.pone.0200025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/18/2018] [Indexed: 11/18/2022] Open
Abstract
Keel fractures represent a major productivity and welfare issue for the laying hen industry with greater than 50% of birds in recent surveys across various commercial operations and nations exhibiting some form of damage by end of lay. While the causes are likely multifactorial and influenced by age, diet, genetic line, and other factors, high energy collisions with house furnishings and conspecifics in the barn are believed to be a major contribution to the frequency and severity of factures. The current study applies a previously described ex vivo impact testing protocol to quantify susceptibility to keel bone damage across an extensive range of collision energies and ages. We also link fracture susceptibility with bone and physiological measures likely to influence skeletal resilience. Further, we applied the impact testing protocol to evaluate the benefit of an omega-3 enriched diet to improve bone health and reduce fracture susceptibility. Our results indicated that fracture susceptibility increased rapidly from 23 weeks of age, peaking at 49.5 weeks of age and thereafter decreasing. Fracture susceptibility also varied with multiple natural characteristics of bone, including mineral density, though the nature of that relationship was dependent on whether an old fracture was present. Severity of the experimental fracture demonstrated considerable variation with collision energy and biomechanical properties. An omega-3 enhanced diet provided a protective effect against fractures, though only in terms of collision energies that were relatively low. In conclusion, the impact testing protocol provided a unique means to assess fracture susceptibility and quantify the role of likely influencing bird-level biological factors, both those that vary naturally as well as when altered through specific interventions.
Collapse
Affiliation(s)
- Michael Toscano
- Center for Proper Housing: Poultry and Rabbits (ZTHZ), Division of Animal Welfare, VPH Institute, University of Bern, Zollikofen, Switzerland
| | - Francesca Booth
- School of Veterinary Sciences, University of Bristol, Lower Langford, North Somerset, England
| | - Gemma Richards
- School of Veterinary Sciences, University of Bristol, Lower Langford, North Somerset, England
| | - Steven Brown
- School of Veterinary Sciences, University of Bristol, Lower Langford, North Somerset, England
| | - Darrin Karcher
- Department of Animal Sciences, Purdue University, West Lafayette, Indiana, United States of America
| | - John Tarlton
- School of Veterinary Sciences, University of Bristol, Lower Langford, North Somerset, England
| |
Collapse
|
20
|
Schulz-Drost S, Krinner S, Langenbach A, Merschin D, Grupp S, Hennig FF, Ekkernkamp A, Mauerer A. The Operative Management of Flail Chest Injuries with Concomitant Sternal Fracture. Chirurgia (Bucur) 2018; 112:573-593. [PMID: 29088557 DOI: 10.21614/chirurgia.112.5.573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2017] [Indexed: 11/23/2022]
Abstract
Background: Flail Chest Injuries (FCI) are one of the most severe thoracic injuries. Moreover, an additional sternal fracture (SF) even worsens the outcome, such as the duration of mechanical ventilation, therefore an surgical fixation of the fractures could be considered in certain cases to improve the weaning from the ventilator. This paper aims to emphasize on the management of different types of SF in FCI. Methods: All surgically treated cases (2012-2016) that showed the combination of FCI and SF have been evaluated for their clinical details, the morphology of the fractures and the technical aspects of the surgical procedure in a retrospective investigation. Results: All of the SF (n=15) had been fixed by locked plate osteosynthesis through a median approach in a supine position. Three main regions of the sternum showed the need for different fixation strategies: the upper manubrium, central and lower corpus sterni. Concomitant rib fractures were addressed either through the same approach or through additional limited incisions. Conclusions: Combinations of SF and FCI are high risc injuries with high demand on surgical skills. They can be properly fixed with a locking plate osteosynthesis through a combination of limited incisions employing different types of plates depending on the type of SF.
Collapse
|
21
|
Lam L. Acute sternal subluxation in an indoor cat. Can Vet J 2018; 59:82-84. [PMID: 29302107 PMCID: PMC5731390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 1-year-old spayed female cat was presented with tachypnea and a protrusion on the ventral thorax. Radiography revealed ventral sternal subluxation between the 6th and 7th sternebrae. There was no evidence of respiratory distress, even after follow-up, and a conservative management approach was successful in this healthy, young, indoor cat.
Collapse
Affiliation(s)
- Louise Lam
- Address all correspondence to Louise Lam; e-mail:
| |
Collapse
|
22
|
Aibinder WR, Torchia ME, Bishop AT, Shin AY. Vascularized Medial Femoral Condyle Graft for Manubrium Nonunion: Case Report and Review of the Literature. J Surg Orthop Adv 2017; 26:173-179. [PMID: 29130879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Fractures of the sternum are rare. Persistent nonunions, however, can lead to chronic pain and significant functional limitations. The vascularized medial femoral condyle is a versatile tool in the surgeon's armamentarium. Traditionally, it has been used as a thin corticoperiosteal graft in the treatment of nonunion of tubular bones. Its use as a structural corticocancellous graft has also been expanding. This report presents a case of a patient with a recalcitrant symptomatic nonunion of the manubrium treated with the unique combined corticoperiosteal and corticocancellous vascularized bone graft from the medial femoral condyle and reviews the literature concerning these uncommon nonunions. (Journal of Surgical Orthopaedic Advances.
Collapse
Affiliation(s)
| | | | - Allen T Bishop
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
23
|
Shaw G, Lessley D, Ash J, Poplin J, McMurry T, Sochor M, Crandall J. Small female rib cage fracture in frontal sled tests. Traffic Inj Prev 2017; 18:77-82. [PMID: 27260566 DOI: 10.1080/15389588.2016.1193599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 05/20/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The 2 objectives of this study are to (1) examine the rib and sternal fractures sustained by small stature elderly females in simulated frontal crashes and (2) determine how the findings are characterized by prior knowledge and field data. METHODS A test series was conducted to evaluate the response of 5 elderly (average age 76 years) female postmortem human subjects (PMHS), similar in mass and size to a 5th percentile female, in 30 km/h frontal sled tests. The subjects were restrained on a rigid planar seat by bilateral rigid knee bolsters, pelvic blocks, and a custom force-limited 3-point shoulder and lap belt. Posttest subject injury assessment included identifying rib cage fractures by means of a radiologist read of a posttest computed tomography (CT) and an autopsy. The data from a motion capture camera system were processed to provide chest deflection, defined as the movement of the sternum relative to the spine at the level of T8. A complementary field data investigation involved querying the NASS-CDS database over the years 1997-2012. The targeted cases involved belted front seat small female passenger vehicle occupants over 40 years old who were injured in 25 to 35 km/h delta-V frontal crashes (11 to 1 o'clock). RESULTS Peak upper shoulder belt tension averaged 1,970 N (SD = 140 N) in the sled tests. For all subjects, the peak x-axis deflection was recorded at the sternum with an average of -44.5 mm or 25% of chest depth. The thoracic injury severity based on the number and distribution of rib fractures yielded 4 subjects coded as Abbreviated Injury Scale (AIS) 3 (serious) and one as AIS 5 (critical). The NASS-CDS field data investigation of small females identified 205 occupants who met the search criteria. Rib fractures were reported for 2.7% of the female occupants. CONCLUSIONS The small elderly test subjects sustained a higher number of rib cage fractures than expected in what was intended to be a minimally injurious frontal crash test condition. Neither field studies nor prior laboratory frontal sled tests conducted with 50th percentile male PMHS predicted the injury severity observed. Although this was a limited study, the results justify further exploration of the risk of rib cage injury for small elderly female occupants.
Collapse
Affiliation(s)
- Greg Shaw
- a University of Virginia , Center for Applied Biomechanics , Charlottesville , Virginia
| | - David Lessley
- a University of Virginia , Center for Applied Biomechanics , Charlottesville , Virginia
| | - Joseph Ash
- a University of Virginia , Center for Applied Biomechanics , Charlottesville , Virginia
| | - Jerry Poplin
- a University of Virginia , Center for Applied Biomechanics , Charlottesville , Virginia
| | - Tim McMurry
- b University of Virginia , PBHS Public Health Sciences Admin , University of Virginia School of Medicine , Charlottesville , Virginia
| | - Mark Sochor
- a University of Virginia , Center for Applied Biomechanics , Charlottesville , Virginia
| | - Jeff Crandall
- a University of Virginia , Center for Applied Biomechanics , Charlottesville , Virginia
| |
Collapse
|
24
|
Murray N, Rypens F, Trudel JS, Cantin MA, Miron MC. Traumatic sternal segment dislocation in a 3-year-old girl: Sonographic findings. J Clin Ultrasound 2017; 45:45-49. [PMID: 27439980 DOI: 10.1002/jcu.22378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/07/2016] [Accepted: 05/14/2016] [Indexed: 06/06/2023]
Abstract
Sternal fractures are uncommon in the pediatric population, and sternal segment dislocations are even rarer with only a few cases reported in the literature. Most cases are secondary to direct trauma to the chest, but nontraumatic dislocations have been reported. The diagnosis can be difficult to establish with standard radiographs, while CT is not desirable in the pediatric population due to the associated irradiation. Ultrasound (US) can be used as the first-line modality to evaluate the sternum. We report the US findings associated with a case of traumatic sternal segment dislocation in a 3-year-old girl. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:45-49, 2017.
Collapse
Affiliation(s)
- Nicolas Murray
- Department of Medical Imaging, CHU de Quebec, 10 Rue de l'Espinay, Quebec City, Canada, G1L 3L5
| | - Françoise Rypens
- Department of Medical Imaging, CHU Sainte-Justine, University of Montreal, 3175 Cote Sainte-Catherine, Montreal, Canada, H3T 1C5
| | - Jean-Sébastien Trudel
- Department of Medical Imaging, Hopital du Haut Richelieu, 920 Boul. Du Seminaire Nord, Saint-Jean-sur-Richelieu, Canada, J3A 1B7
| | - Marie-Andrée Cantin
- Department of Orthopedic Surgery, CHU Sainte-Justine, University of Montreal, 3175 Cote Sainte-Catherine, Montreal, Canada, H3T 1C5
| | - Marie-Claude Miron
- Department of Medical Imaging, CHU Sainte-Justine, University of Montreal, 3175 Cote Sainte-Catherine, Montreal, Canada, H3T 1C5
| |
Collapse
|
25
|
Ihnát Rudinská L, Hejna P, Smatanová M, Ihnát P, Dvořáček I. [Injuries associated with cardiopulmonary resuscitation in non-survivors after out-of-hospital cardiac arrest (autopsy study)]. Soud Lek 2017; 62:18-21. [PMID: 28597665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aim of the present study is to investigate incidence and seriousness of CPR-associated injuries on a cohort of CPR non-survivors after out-of-hospital cardiac arrest in the Moravian-Silesian region. In total, 80 persons were included in the study within the study period (2012 - 2015). CPR-associated injuries were identified in 75 (93.7 %) persons, multiple injuries were found in 73 persons. Spectrum of identified injuries covered skin injuries of the upper half of the body, head and neck injuries, rare abdominal injuries and very frequent thorax injuries. Sternal fractures were found in 53 (63.3 %) persons. Rib fractures were identified in 59 (73.0 %) persons; rib fractures were usually multiple (mean number of broken ribs was 7.6 per person). Intra-thoracic injuries were diagnosed in 33 (41.2 %) persons - findings of lung contusions and lacerations, transmural heart contusions, hemothorax and hemopericard. The vast majority of identified intra-thoracic injuries were considered clinically relevant (provided the fact that return of spontaneous circulation had been achieved). Intraabdominal injuries (liver and spleen injuries) were identified in 15 (18.7 %) of persons. Vast majority of these injuries was clinically irrelevant. We have found clinically serious injuries (spleen rupture and liver dilacerations) in 3 (3.7 %) persons. Outcomes of our study suggest that CPR-associated injuries are very common, usually multiple, and in some cases they might be even potentially lethal (if return of spontaneous circulation is achieved).Key words: cardiopulmonary resuscitation - cardiac arrest - injuries - autopsy study - sternal and rib fractures.
Collapse
|
26
|
Mertz HJ, Prasad P, Dalmotas DJ, Irwin AL. Age-Specific Injury Risk Curves for Distributed, Anterior Thoracic Loading of Various Sizes of Adults Based on Sternal Deflections. Stapp Car Crash J 2016; 60:1-9. [PMID: 27871091 DOI: 10.4271/2016-22-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Injury Risk Curves are developed from cadaver data for sternal deflections produced by anterior, distributed chest loads for a 25, 45, 55, 65 and 75 year-old Small Female, Mid-Size Male and Large Male based on the variations of bone strengths with age. These curves show that the risk of AIS ≥ 3 thoracic injury increases with the age of the person. This observation is consistent with NASS data of frontal accidents which shows that older unbelted drivers have a higher risk of AIS ≥ 3 chest injury than younger drivers.
Collapse
|
27
|
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.
Collapse
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
| | | | | |
Collapse
|
28
|
Berglund B, Claesson C, Nilsson LE, Hanberger H. High Prevalence of Heterogeneously Glycopeptide-Intermediate Coagulase-Negative Staphylococci in Sternal Wounds. Antimicrob Agents Chemother 2016; 60:5097-8. [PMID: 27216070 PMCID: PMC4958198 DOI: 10.1128/aac.00217-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Björn Berglund
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Carina Claesson
- Department of Clinical Microbiology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Lennart E Nilsson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Håkan Hanberger
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
29
|
DiGiacomo JC, Angus LDG. Occult Sternal Fractures Identified by Bone Scintigraphy Occult Sternal Fractures. Am Surg 2015; 81:E424-E425. [PMID: 26736151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Jody C DiGiacomo
- Division of Surgical Critical Care, Department of Surgery, The Long Island Comprehensive Trauma Center, Nassau University Medical Center, East Meadow, New York, USA
| | | |
Collapse
|
30
|
Santarpino G, Gazdag L, Sirch J, Vogt F, Ledwon M, Fischlein T, Pfeiffer S. A Retrospective Study to Evaluate Use of Negative Pressure Wound Therapy in Patients Undergoing Bilateral Internal Thoracic Artery Grafting. Ostomy Wound Manage 2015; 61:26-30. [PMID: 27763880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Bilateral internal thoracic artery (BITA) grafting may be associated with a higher risk of postoperative deep sternal wound infection than monolateral internal thoracic artery grafting due to a limited blood supply to the thoracic chest wall. Because preliminary studies suggest negative pressure wound therapy (NPWT) may reduce the risk of infection, a retrospective chart review of 129 patients who underwent BITA between February 2003 and October 2014 was conducted. Of those, 21 patients received NPWT for 5 days immediately following surgery and the incisions of 108 patients were covered with a conventional gauze dressing. Patient demographic and history variables as well as surgical procedure and outcome variables were abstracted. Outcome variables assessed included infection, need for transfusion, and length of hospital stay. The NPWT group was significantly younger (average age 55.9 ± 7.6 versus 60 ± 10.5 years, P = 0.049), had fewer urgent/emergent surgeries (4 [19%] versus 36 [33.3%], P = 0.247), and had significantly lower surgical risk scores (2.0 ± 2.3 versus 3.8 ± 2.8, P = 0.010). The rate of deep sternal wound infections was lower in the NPWT than in the control group, but the difference was not statistically significant (0% versus 5.6%, P = 0.336). Sternal instability was noted in 4 control patients, requiring wound re-exploration versus 0 in the NPWT group (3.7% versus 0%, P = 0.487). One (1) patient in the NPWT group had postoperative bleeding that required removal of the device. The rates of re-thoracotomy due to bleeding were 9.3% in the control compared to 4.8% in the NPWT group (P = 0.435), which translated into a greater need for blood transfusions (1.77 ± 3.4 units versus 0.3 3± 0.7 units, P = 0.056) and larger chest drainage volume (997.8 ± 710 mL versus 591.2 ± 346 mL, P = 0.012) in the control group. Hospital stay was longer in the control group, but the difference was not statistically significant (12 ± 8.8 days versus 9.4 ± 4.2 days, P = 0.184). These preliminary results are encouraging, and prospective, randomized, controlled clinical studies to compare the efficacy, effectiveness, and costeffectiveness of NPWT to other wound management modalities following cardiac surgery are warranted.
Collapse
Affiliation(s)
| | - Lazlo Gazdag
- Paracelsus Medical University, Klinikum Nürnberg. Nuremberg, Germany
| | - Joachim Sirch
- Paracelsus Medical University, Klinikum Nürnberg. Nuremberg, Germany
| | - Ferdinand Vogt
- Paracelsus Medical University, Klinikum Nürnberg. Nuremberg, Germany
| | - Miroslaw Ledwon
- Paracelsus Medical University, Klinikum Nürnberg. Nuremberg, Germany
| | - Theodor Fischlein
- Paracelsus Medical University, Klinikum Nürnberg. Nuremberg, Germany
| | - Steffen Pfeiffer
- Paracelsus Medical University, Klinikum Nürnberg. Nuremberg, Germany
| |
Collapse
|
31
|
Abstract
Basic surgical instrumentation for avian soft tissue surgery includes soft tissue retractors, microsurgical instrumentation, surgical loupes, and head-mounted lights. Hemostasis is fundamental during the surgical procedures. The indications, approach, and complications associated with soft tissue surgeries of the integumentary (digit constriction repair, feather cyst excision, cranial wound repair, sternal wound repair, uropygial gland excision), gastrointestinal (ingluviotomy, crop biopsy, crop burn repair, celiotomy, coelomic hernia and pseudohernia repair, proventriculotomy, ventriculotomy, enterotomy, intestinal resection and anastomosis, cloacoplasty, cloacopexy), respiratory (rhinolith removal, sinusotomy, tracheotomy, tracheal resection and anastomosis, tracheostomy, pneumonectomy) and reproductive (ovocentesis, ovariectomy, salpingohysterectomy, cesarean section, orchidectomy, vasectomy, phallectomy) systems are reviewed.
Collapse
Affiliation(s)
- David Sanchez-Migallon Guzman
- Avian and Exotic Pet Medicine and Surgery, School of Veterinary Medicine University of California Davis, One Shields Avenue, 2108 Tupper Hall, Davis, CA 95616, USA.
| |
Collapse
|
32
|
Hanschen M, Kanz KG, Kirchhoff C, Khalil PN, Wierer M, van Griensven M, Laugwitz KL, Biberthaler P, Lefering R, Huber-Wagner S. Blunt Cardiac Injury in the Severely Injured - A Retrospective Multicentre Study. PLoS One 2015; 10:e0131362. [PMID: 26136126 PMCID: PMC4489656 DOI: 10.1371/journal.pone.0131362] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 06/01/2015] [Indexed: 11/21/2022] Open
Abstract
Background Blunt cardiac injury is a rare trauma entity. Here, we sought to evaluate the relevance and prognostic significance of blunt cardiac injury in severely injured patients. Methods In a retrospective multicentre study, using data collected from 47,580 patients enrolled to TraumaRegister DGU (1993-2009), characteristics of trauma, prehospital / hospital trauma management, and outcome analysis were correlated to the severity of blunt cardiac injury. The severity of cardiac injury was assessed according to the abbreviated injury score (AIS score 1-6), the revised injury severity score (RISC) allowed comparison of expected outcome with injury severity-dependent outcome. N = 1.090 had blunt cardiac trauma (AIS 1-6) (2.3% of patients). Results Predictors of blunt cardiac injury could be identified. Sternal fractures indicate a high risk of the presence of blunt cardiac injury (AIS 0 [control]: 3.0%; AIS 1: 19.3%; AIS 2-6: 19.1%). The overall mortality rate was 13.9%, minor cardiac injury (AIS 1) and severe cardiac injury (AIS 2-6) are associated with higher rates. Severe blunt cardiac injury (AIS 4 and AIS 5-6) is associated with a higher mortality (OR 2.79 and 4.89, respectively) as compared to the predicted average mortality (OR 2.49) of the study collective. Conclusion Multiple injured patients with blunt cardiac trauma are at high risk to be underestimated. Careful evaluation of trauma patients is able to predict the presence of blunt cardiac injury. The severity of blunt cardiac injury needs to be stratified according to the AIS score, as the patients’ outcome is dependent on the severity of cardiac injury.
Collapse
Affiliation(s)
- Marc Hanschen
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Karl-Georg Kanz
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Philipe N. Khalil
- Department of General, Visceral-, Transplantation-, Vascular- and Thoracic Surgery—Campus Grosshadern, University Hospital Munich (LMU), Munich, Germany
| | - Matthias Wierer
- Department of General, Visceral-, Transplantation-, Vascular- and Thoracic Surgery—Campus Grosshadern, University Hospital Munich (LMU), Munich, Germany
| | - Martijn van Griensven
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Karl-Ludwig Laugwitz
- I. Medical Department, Cardiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Rolf Lefering
- IFOM–Institute for Research in Operative Medicine, University Witten/Herdecke, Faculty of Health, Cologne, Germany
| | - Stefan Huber-Wagner
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- * E-mail:
| | - TraumaRegister DGU
- Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society (Sektion NIS), Berlin, Germany
| |
Collapse
|
33
|
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.
Collapse
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
| |
Collapse
|
34
|
Nakagawa T, Tsuboi T, Wada A, Nito M, Aruga N, Oiwa K, Masuda R, Iwazaki M. Sternal Segment Dislocation in a Child Treated by Conservative Observation. Tokai J Exp Clin Med 2015; 40:27-28. [PMID: 26150179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/10/2015] [Indexed: 06/04/2023]
Abstract
Sternal segment dislocation is rare in children, with only eight cases appearing in the literature. Four of the six reports recommended surgical treatment such as excision or open reduction and fixation [1-4], while the remaining two reports recommended conservative observation. Therefore, it remains unclear whether surgical treatment is necessary. We report a case of sternal segment dislocation in a child. Although the segment had rotated 90°, it was remodeled. We now believe that surgical treatment is not necessary for this condition.
Collapse
Affiliation(s)
- Tomoki Nakagawa
- Division of General Thoracic Surgery, Department of Surgery, Tokai University School of Medicine, 143 Simokasuya, Isehara, Kanagawa 259-1193, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Charafeddine AH, Stone ME, Reddy SH, Teperman SH, Kaban JM, Cohen-Levy WB. Anterior chest wall disassociation: a pattern associated with serious underlying injury. Am Surg 2015; 81:E244-E245. [PMID: 26031254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
36
|
Dekkers M, Brouwers L, Rutten AMF. [A man with a painful sternum]. Ned Tijdschr Geneeskd 2015; 159:A9039. [PMID: 26374724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We present a case of a 81-year-old man with blunt chest trauma after a car accident. Trauma screening at the emergency department showed multiple rib fractures and a fractured sternum. We made the diagnosis floating sternum. Cardiac contusion may occur after chest-wall trauma, but was not present in this case.
Collapse
|
37
|
Galema G, Stirler VMA, Ariës MJH. [A woman with a seat belt sign after a car accident]. Ned Tijdschr Geneeskd 2015; 160:A9355. [PMID: 26934433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 48-year-old woman presented with a cervicothoracic seat belt sign after a car accident as a front seat passenger. The CT scan showed right common carotid artery dissection with a pseudoaneurysm, a right clavicle fracture, sternal fracture, multiple rib fractures left and a laceration of the spleen. She did not develop any neurologic deficits.
Collapse
|
38
|
Šafránek J. [Sternal fractures and their surgical treatment]. Acta Chir Orthop Traumatol Cech 2015; 82:76-79. [PMID: 25748665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE OF THE STUDY Sternal fractures occur most frequently in vehicle accidents, then due to falls from a height and by other blunt chest trauma. Most of these injuries are simple, non-displaced fractures only rarely requiring surgical management. Based on a retrospective analysis, the authors present their experience with the treatment of sternal fractures, emphasizing the use of osteosynthesis. MATERIAL AND METHODS A group of 293 patients treated for fresh sternal fractures in the period from 2004 to 2013 were evaluated. Their median age was 47.5 years (range, 2 to 86 years). They were allocated to two groups according to the method of treatment, ie., conservative versus surgical. The two groups were compared in the following characteristics: mechanism and extent of trauma, methods of treating the fracture and associated injuries and troponin-T and myoglobin values. RESULTS Of the 293 patients, 16 had surgery (surgical group) and the remaining patients were treated conservatively. Eleven patients (3.8%) had surgery for instability or chest wall deformity. Five patients (1.7%) underwent urgent cardiovascular surgery due to complications of sternum fracture. In the surgical group, comminuted fractures were more frequent (p=0.0003), rib fractures had a higher incidence rate (p=0.0442), concomitant abdominal injuries occurred more often (p=0.0173) and serum levels of troponin-T and myoglobin were higher (p<0.0001 and p=0.0114, respectively) than in the other group. DISCUSSION The majority of sternal injuries (90-95%) are non-displaced, simple fractures that heal spontaneously. In complicated fractures, reduction and fragment fixation relieve pain, provide prevention from respiratory complications and make the duration of mechanical ventilation shorter. Our results show that osteosynthesis was mostly indicated in displaced and comminuted fractures or severe chest deformity. Concomitant intra-abdominal injury is caused by a flexion mechanism or an impact on the front of the body. Serious sternal fractures are associated with increased serum levels of troponin-T and myoglobin. CONCLUSIONS Plate fixation is a suitable method of stable osteosynthesis in complicated sternal fractures. It shortens the duration of mechanical ventilation and repairs post-traumatic chest wall deformities.
Collapse
|
39
|
Targońska S, Kozioł MM, Czajkowski M, Stążka J, Kozioł-Montewka M. [Sternal wound complications after cardiac surgery--a case report]. Wiad Lek 2015; 68:95-98. [PMID: 26094341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The authors presents case report of a 59-years-old man with triple vessel coronary artery disease, hypertension after myocardial infarction of the inferior wall with sternal wound complcations after coronary bypass grafting (CABG). On the fourth postoperative day the patient developed sternal dehiscence with wound infection. Infection was caused by Staphylococcus haemolyticus--coagulase-negative methicillin-resistant strain, MRCNS. An antimicrobial therapy and negative pressure wound therapy were used for complete wound healing.
Collapse
|
40
|
Zheng S, Chen H, Sun C, Huang Z, Bian H, Liu Z, Ma L, Li H, Deng Y, Wang H, Lai W. [Classification and management of sternal wound complications after cardiac surgery]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2014; 28:1120-1124. [PMID: 25509778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To define the classification of sternal wound complications after cardiac surgery and to explore the appropriate surgical treatment. METHODS Between July 2008 and January 2014, 260 patients with sternal wound complications after cardiac surgery were treated. There were 124 males and 136 females, aged 11-75 years (mean, 49.5 years). The disease duration was 13-365 days (mean, 26.6 days) with a wound length of 1-25 cm (mean, 13.4 cm). The wounds were divided into type I (n = 70), type II (n = 64), type III (n = 42), type IV (n = 78), and type V (n = 6) according to self-generated classification for sternal wound complications after cardiac surgery. After debridement, wounds of type I and type II were repaired with local flap transplantation; wounds of type III were repaired with local flap transplantation combined with butterfly sternal fixation (n = 28), with bilateral pectoralis muscle flap combined with butterfly sternal fixation (n = 11), and with bilateral pectoralis muscle flap (n = 3); wounds of type IV were repaired with bilateral pectoralis muscle flap (n = 65), rectus abdominis muscle flap (n = 5), and pedicled omental flap (n = 8); and wounds of type V were repaired with pedicled omental flap. RESULTS All the operations were successfully performed. Three patients died after pedicled omental flap repair, including 1 case of type IV and 2 cases of type V. The hospitalization time were 4-86 days (mean, 18.3 days). Primary wound healing was obtained in 248 cases (96.5%); poor healing occurred in 9 patients, which were cured after second surgery in 8 cases and after the third surgery in 1 case. CONCLUSION The surgical treatment based on self-generated classification is appropriate to sternal wound complications after cardiac surgery. It can provide clinical evidence for the choice of subsequent operation.
Collapse
|
41
|
Audette JS, Emond M, Scott H, Lortie G. Investigation of myocardial contusion with sternal fracture in the emergency department: multicentre review. Can Fam Physician 2014; 60:e126-e130. [PMID: 24522690 PMCID: PMC3922581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To describe the use of initial electrocardiogram (ECG), follow-up ECG or equivalent monitoring, and troponin I in patients presenting with sternal fracture who are assessed in emergency departments or by front-line physicians. DESIGN Multicentre descriptive retrospective study. SETTING Two traumatology teaching centres in Quebec city, Que. PARTICIPANTS Fifty-four trauma patients presenting with sternal fracture. INTERVENTIONS Assessment of the use of initial ECG, ECG or equivalent monitoring 6 hours after trauma, and troponin administration. MAIN OUTCOME MEASURES In terms of ECG use, quality comparison criteria were selected on the basis of expert opinions in 4 studies. An initial ECG and a follow-up ECG 6 hours after trauma or cardiac monitoring 6 hours after trauma were recommended by most authors for diagnosing myocardial contusion in cases of sternal fracture. Serum troponin I administered 4 to 8 hours after chest trauma was also recommended by some as an effective means of detecting substantial arrhythmia secondary to myocardial contusion. Descriptive univariate analyses and tests were performed. A P < .05 was considered significant. RESULTS Thirty-nine patients (72%) were assessed initially with ECGs; after 6 hours in the emergency department, 18 of these patients (33%) had follow-up ECGs or equivalent cardiac monitoring. Sixteen patients (30%) were assessed by means of troponin I dosage. Two patients (4%) presented with ECG abnormalities and only 1 patient (2%) presented with an elevated troponin I level. CONCLUSION Emergency physicians must increase their use of ECG in initial or follow-up diagnosis for trauma patients presenting with sternal fracture to detect myocardial contusion and arrhythmia. The use of troponin in conjunction with ECG is also suggested for this population in order to identify patients at risk of complications secondary to myocardial contusion.
Collapse
Affiliation(s)
- Jean-Sébastien Audette
- Laval University, Department of Emergency Medicine, 750 Calixa-Lavallée Ave, Unit 7, Quebec, QC G1S 3G6.
| | | | | | | |
Collapse
|
42
|
Gürses MS, Akan O, Eren B, Durak D, Türkmen N, Cetin S. Medicolegal aspects of atypical firearm injuries: a case report. Soud Lek 2014; 59:10-12. [PMID: 24625021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Our case was a twenty year-old man, who was injured during the military duty with G3 infantry rifle in the training area. An atypical firearm entry wound on the left side of sternum which was 4.5 cm in diameter, and was surrounded by six irregular skin burn wounds by a flash-suppressor and a 0.7 cm diameter firearm exit wound at space on the left midscapular line. Our case emphasizes that the interpretation of properties of these atypical firearm entry wounds need to be carefully assessed by physicians.
Collapse
|
43
|
Schulz-Drost S, Mauerer A, Grupp S, Hennig FF, Blanke M. Surgical fixation of sternal fractures: locked plate fixation by low-profile titanium plates--surgical safety through depth limited drilling. Int Orthop 2013; 38:133-9. [PMID: 24122047 DOI: 10.1007/s00264-013-2127-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 09/13/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE Operative treatment of sternal fractures has become a matter of increasing interest. Anterior plating seems to be the most appropriate method for fixing sternal fractures. However, there are several concerns in relation to the operative procedure such as severe injuries to mediastinal organs, patient comfort and proper stabilisation, for example. This paper describes a safe method of anterior sternal plating using locked plate fixation with limited depth drilling. METHODS Ten patients with sternal fractures were included in this cohort study and were treated by anterior plating using one or two plates in parallel through a median approach to the sternum. Follow up was performed after six weeks, 12 weeks and six months. RESULTS Follow up revealed no serious complications. One patient suffered from postoperative wound seroma. No problems were caused by the plates. CONCLUSIONS Sternal plating using low profile locked titanium plates seems to be a safe and stable method with a high level of patient comfort.
Collapse
|
44
|
Aigner P, Eskandary F, Schlöglhofer T, Gottardi R, Aumayr K, Laufer G, Schima H. Sternal force distribution during median sternotomy retraction. J Thorac Cardiovasc Surg 2013; 146:1381-6. [PMID: 24075560 DOI: 10.1016/j.jtcvs.2013.07.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 03/08/2013] [Revised: 07/12/2013] [Accepted: 07/26/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Median sternotomy is the access of choice in cardiac surgery. Sternal retractors exert significant forces on the thoracic cage and might cause considerable damage. The aim of this study was to determine the effects of retractor shape on local force distribution to obtain criteria for retractor design. METHODS Two types of sternal retractors (straight [SSR] and curved [CSR]) were equipped with force sensors. Force distribution, total force, and displacement were recorded to a spread width of 10 cm in 18 corpses (11 males and 7 females; age, 62 ± 12 years). Both retractors were used in alternating sequence in 4 iterations in every corpse. Data were compared with respect to the different retractor blade shapes. RESULTS Maximum total forces for full retraction of both retractors resulted in 349.4 ± 77.9 N. Force distribution during the first retraction for the cranial/median/caudal part of the sternum was 101.5 ± 43.9/29.1 ± 33.9/63.0 ± 31.4 N for the SSR and 38.7 ± 41.3/80.9 ± 64.5/34.0 ± 25.8 N for the CSR, respectively. During the 4 spreading cycles, the average force decreased from 224.6 ± 61.3 N in the first to 110.8 ± 39.8 N in the fourth iteration. The mean total force for the first retraction revealed 226.4 ± 71.9 N for the CSR and 222.8 ± 52.9 N for the SSR. CONCLUSIONS The shape of sternal retractors considerably influences the force distribution on the sternal incision. In the SSR, forces on the cranial and caudal sternum are significantly higher than in the median section, whereas in the CSR, forces in the median section are highest.
Collapse
Affiliation(s)
- Philipp Aigner
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria.
| | | | | | | | | | | | | |
Collapse
|
45
|
Senthilkumaran S, Menezes RG, Jayaraman S, Thirumalaikolundusubramanian P. Sternal fracture after cardioversion: time to probe. Am J Emerg Med 2013; 31:1532-3. [PMID: 23954362 DOI: 10.1016/j.ajem.2013.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 07/15/2013] [Indexed: 11/18/2022] Open
Affiliation(s)
- Subramanian Senthilkumaran
- Department of Emergency, Critical Care, Sri Gokulam Hospital, Research Institute, Salem, Tamil Nadu, India.
| | | | | | | |
Collapse
|
46
|
Panasenko SI, Sheĭko VD, Hur'ev SO, Burluka VV, Baramiia NM. [Methodological paradoxes on paradigm changes of surgical tactics in traumatic instability of sternocostal frame]. Klin Khir 2013:54-56. [PMID: 24171291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Scientific literature about the surgical tactics in traumatic instability sternocostal frame was conduct. Studies have shown that this type of trauma expediently are useful minimal invasive osteosynthesis. The original method of osteosynthesis ribs and sternum external fixation apparatus were proposed, its application promoted to significantly improved the results of treatment.
Collapse
|
47
|
Oyetunji TA, Jackson HT, Obirieze AC, Moore D, Branche MJ, Greene WR, Cornwell EE, Siram SM. Associated injuries in traumatic sternal fractures: a review of the National Trauma Data Bank. Am Surg 2013; 79:702-705. [PMID: 23816003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sternal fractures occur infrequently with blunt force trauma. The demographics and epidemiology of associated injuries have not been well characterized from a national trauma database. The National Trauma Data Bank was queried for patients with closed sternal fractures. The demographics were analyzed by age, gender, mechanism and indicators of anatomic and physiologic injuries. Types of commonly associated injuries were also determined. A total of 23,985 records were analyzed. Males accounted for 68.3 per cent and whites 70.9 per cent. Motor vehicle crash was the leading mechanism. More than 56 per cent had severe injuries based on Injury Severity Score (greater than 15) and 17 per cent with Glasgow Coma Score 8 or less. Crude mortality was 7.9 per cent. The majority (57.8%) and approximately one-third (33.7%) of the patients had rib fractures and lung contusions, respectively, 22.0 per cent with closed pneumothorax, 21.6 per cent had a closed thoracic vertebra fracture, 16.9 per cent with lumbar spine fracture, 3.9 per cent with concussion, and blunt cardiac injury in 3.6 per cent. Sternal fractures are usually associated with severe blunt trauma. Lung contusion remains the leading associated injury followed by vertebral spine fractures. Cardiac injuries are less frequent and vascular injuries less so. Mechanism of injury and presence of sternal fractures should alert providers to these potential associated injuries.
Collapse
Affiliation(s)
- Tolulope A Oyetunji
- Department of Surgery, Howard University College of Medicine, Washington, DC 20060, USA.
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Kůdela M, Grossová I, Strejc P. [Traumatic changes of intrathoracic organs due to external mechanical cardiopulmonary resuscitation. Case reports]. Soud Lek 2013; 58:42-44. [PMID: 23964585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
UNLABELLED External mechanical resuscitation systems were developed for continuous and effective chest compression with the goal to increase the probability of spontaneous blood circulation renew. We describe results of four autopsy cases, where the external mechanical resuscitation by system Lucas (n=3) and AutoPulse (n=1) was performed prior to death. In all the cases were found traumatic changes which are commonly described in various studies such as skin abrasions on the chest, multiple rib fractures, fracture of the sternum and hematoma in the mediastinum or pericardium. In addition to these usual traumatic changes accompanying mechanical cardiopulmonary resuscitation we have observed injuries of intrathoracic organs, mainly the contusions of the heart and contusions and laceration of the lungs. In addition to these changes were in one case, associated with prolonged AutoPulse resuscitation, found ruptures of intima of the right common carotid artery. These injuries, with few exceptions, are not commonly described even over much wider number of examined persons. Injuries of the abdominal organs in connection with mechanical resuscitation, as described in a few case reports, were not present. However in one case there was found contusion of myocardium due to the external resuscitation by the Lucas system with clinical manifestation of sudden coronary incident even though the cause of death was massive thrombotic embolism to pulmonary arteries. All reported cases were similar in the relatively long-lasting mechanic cardiopulmonary resuscitation and prolonged time of dying of the patients. KEYWORDS cardiopulmonary resuscitation - Lucas - AutoPulse - intrathoracic injury.
Collapse
|
49
|
Chermiti Ben Abdallah F, Boudaya MS, Chtourou A, Taktak S, Mahouachi R, Ayadi A, Ben Kheder A. [Sternal tuberculosis causing spontaneous fracture of the sternum]. Rev Pneumol Clin 2013; 69:89-92. [PMID: 23474101 DOI: 10.1016/j.pneumo.2013.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 01/04/2013] [Accepted: 01/21/2013] [Indexed: 06/01/2023]
Abstract
Sternal tuberculosis is an uncommon condition. Few cases have been reported. We report the case of a 74-year-old man, presented with a swelling and pain of the anterior chest wall associated to worsening of general state. All routine investigations were normal. Chest radiograph in lateral view showed sternal and chest wall hypertrophy with spontaneous fracture of the sternum. Computed tomography (CT) scan demonstrated ring-enhancing hypodense soft tissue mass surrounding the sternum with sternal fracture. Tuberculosis diagnosis was confirmed by histological study of the mass biopsy. We noted clinical and radiological recovery with medical tuberculosis treatment.
Collapse
|
50
|
|