Sternal Fractures And Associated Injuries: A Three-year Clinical Experience

Chapter 7 provides an overall look at sternum fracture. The sternum is a flat bone at the anterior center of the chest, which protects the mediastinum. The sternum along with the ribs and vertebrae form the thoracic cage, which protects the thoracic organs and vessels. Fractures are usually associated with direct blunt trauma which most commonly occurs during motor vehicle accidents or from vigorous cardiopulmonary resuscitation. Significant mortality may be associated with displaced sternal fractures because of aortic, cardiac, or pulmonary injury. CT examination has surpassed radiographs in the assessment of sternal fractures and adds identification of secondary findings. It has superior sensitivity to radiography and is valuable in diagnosing serious associated injuries.

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STERNAL FRACTURES. ASSOCIATED INJURIES AND MANAGEMENT

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-199307000-00009 ◽

1993 ◽

Vol 35 (1) ◽

pp. 55-60 ◽

Cited By ~ 71

Author(s):

Michael W. Hills ◽

Andrea M. Delprado ◽

Stephen A. Deane

Keyword(s):

Associated Injuries ◽

Sternal Fractures

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Location of Sternal Fractures as a Possible Marker for Associated Injuries

Emergency Medicine International ◽

10.1155/2013/407589 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 9

Author(s):

Max J. Scheyerer ◽

Stefan M. Zimmermann ◽

Samy Bouaicha ◽

Hans-Peter Simmen ◽

Guido A. Wanner ◽

...

Keyword(s):

Thoracic Spine ◽

Head Injuries ◽

Fracture Morphology ◽

Associated Injuries ◽

Concomitant Injuries ◽

Fracture Location ◽

Chest Injuries ◽

Severity Of Injury ◽

Manubrium Sterni ◽

Sternal Fractures

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

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Epidemiology of Sternal Fractures

The American Surgeon ◽

10.1177/000313480907500510 ◽

2009 ◽

Vol 75 (5) ◽

pp. 401-404 ◽

Cited By ~ 17

Author(s):

Gustavo Recinos ◽

Kenji Inaba ◽

Joseph Dubose ◽

Galinos Barmparas ◽

Pedro G. R. Teixeira ◽

...

Keyword(s):

Blunt Trauma ◽

Motor Vehicle ◽

Rib Fractures ◽

Common Mechanism ◽

Mechanism Of Injury ◽

Associated Injuries ◽

Sternal Fracture ◽

Significant Difference ◽

Aortic Injuries ◽

Sternal Fractures

The epidemiology of sternal fractures has been poorly described. The objective of this study was to examine the demographics, outcomes and injuries associated with sternal fractures. The trauma registry at a level I trauma center was retrospectively reviewed to identify all patients with sternal fractures over a 10 year period. Demographic data collected included age, gender, mechanism of injury and injury severity score. Patients were analyzed according to age ≤ 55 or > 55 years. During the 10-year study period, a total of 37,087 patients were admitted to the emergency department. Of these, 125 (0.33%) had a sternal fracture. The average age was 44 ± 17 years, with 76.0 per cent being male. The most common mechanism of injury was motor vehicle collision (68%) followed by auto vs. pedestrian (18%). Associated rib fractures occurred in 49.6% of the population, cardiac contusions in 8.0%, thoracic aortic injuries in 4.0 per cent and heart lacerations in 2.4 per cent of patients. Associated rib fractures were more likely to occur in patients over the age of 55 (66.7% vs 44.2%, P = 0.032) as well as a traumatic hemothorax (15.8% vs 40.0%, P = 0.005). However, no significant difference in mortality was observed between the two age groups (16.8% vs. 26.7%, OR: 0.56, 95% CI, 0.21 to 1.47; P = 0.234). Sternal fractures are a rare sequela of blunt trauma. Associated injuries are common, including rib fractures and soft tissue contusions. Associated cardiac and aortic injuries are rare but highly lethal and should be screened for on the initial chest CT scan. After appropriate exclusion of associated injuries, the majority of patients diagnosed with a sternal fracture following blunt trauma can be safely discharged to home.

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Associated Injuries in Traumatic Sternal Fractures: A Review of the National Trauma Data Bank

The American Surgeon ◽

10.1177/000313481307900714 ◽

2013 ◽

Vol 79 (7) ◽

pp. 702-705 ◽

Cited By ~ 20

Author(s):

Tolulope A. Oyetunji ◽

Hope T. Jackson ◽

Augustine C. Obirieze ◽

Danier Moore ◽

Marc J. Branche ◽

...

Keyword(s):

Injury Severity ◽

Motor Vehicle ◽

Cardiac Injury ◽

Data Bank ◽

Motor Vehicle Crash ◽

Associated Injuries ◽

Severe Injuries ◽

National Trauma ◽

National Trauma Data Bank ◽

Sternal Fractures

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.

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