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A 54-year-old male driver was injured in a car crash in which his front-side passenger died at the scene. The initial assessment indicated that he was conscious and able to recall the accident. His vital signs included blood pressure of 155/95 mm Hg, heart rate of 112 beats/min, and respiratory rate of 21 breaths/min, and he complained of stabbing retrosternal pain. A palpable sternal fracture with a tender contusion, a discrepancy between the blood pressures between the arms, and diminished femoral pulses were other findings. With a thoracic aortic pseudoaneurysm suspicion, the emergency physician maintained the patient's systolic blood pressure around 100 mm Hg and his heart rate less than 100 beats/min. Because of the need for urgent medical interventions, the emergency physician decided to transport him by air to the nearest advanced trauma center. After accordance with the trauma center and the air medical crew, the air transportation began. The patient subsequently decompensated with bradycardia and hypotension to cardiac arrest, for which 30 minutes of cardiopulmonary resuscitation unfortunately proved unsuccessful. The forensic report indicated an aortic pseudoaneurysm rupture of the proximal descending aorta with a massive hematoma that was a possible cause of death.

A 63-year-old patient was admitted with a sternal fracture and mass. On evaluation, most of the body of the sternum had been destroyed by a tumor. Radical resection of the sternum was performed and part of the major pectoral muscles adherent to the sternal tumor was also resected. The chest wall defect was reconstructed with mesh, bone cement, and a titanium rib plate system. Reconstruction with this method seemed to be an appropriate procedure to prevent instability of the chest wall.

Purpose Traumatic sternal fractures are rare but quite disabling injuries. Timely fixation of sternal fractures reduces pain and prevents respiratory complications. However, the fixation technique should be simple, effective, and readily available in local circumstances. Methods From January 2014 to March 2020, seven patients with sternal fracture/ dislocation underwent steel wire fixation with the new “Timala” technique. In this technique, adjacent ribs are anchored with two steel wires to form an “X” in front of the fractured segment of the sternum. Patients were followed up clinically and radiologically. Results Six of the patients were men and one was a female. Five of them had injuries due to falls and two were injured in road traffic accidents. Their age ranged from 18 years to 76 years, with a median age of 41 years. All seven patients experienced immediate recovery from pain and showed evidence of fracture healing on postoperative chest X-rays and clinical examinations. Conclusions Anchoring ribs to fix the sternum with steel wire is a safe, effective, easily available, and reproducible method to fix sternal fractures or dislocations.

Background Rib fractures are common after motor vehicle collisions. The hormonal changes associated with pregnancy decrease the stiffness and increase the laxity of cartilage and tendons. The effect of these changes on injury mechanics is not completely understood. Objectives To compare the incidences of chest wall injury following blunt thoracic trauma between pregnant and nonpregnant women. Methods The authors conducted a retrospective review of female patients seen at a level I trauma center from 2009 to 2017 after a motor vehicle collision. Patient characteristics were compared to determine if pregnancy affected the incidence of chest wall injury. Statistics were calculated with SPSS version 24 and are presented as mean (SD) or median (interquartile range). Results In total, 1618 patients were identified. The incidence of rib/sternal fracture was significantly lower in pregnant patients (7.9% vs 15.2%, P = .047), but the incidence of intrathoracic injury was similar between the groups. Pregnant and nonpregnant patients with rib/sternal fractures had similar Injury Severity Score results (21 [13-27] vs 17 [11-22], P = .36), but pregnant patients without fractures had significantly lower scores (1 [0-5] vs 4 [1-9], P < .001). Conclusions Pregnant patients have a lower rate of rib fracture after a motor vehicle collision than nonpregnant patients. The difference in injury mechanics may be due to hormonal changes that increase elasticity and resistance to bony injury of the ribs. In pregnant trauma patients, intrathoracic injury without rib fracture should raise concerns about injury severity. A multicenter evaluation of these findings is needed.

BACKGROUND: Sternal fracture can result from multiple types of severe chest trauma and carries significant risk. Surgical fixation is an effective method for sternal fracture. METHODS: The clinical data of patients with sternal fractures who presented to our hospital between August 2016 and July 2019 were collected. The 42 patients were divided into three groups, with 15 patients treated by internal fixation with NI-TI memory alloy embracing fixator, 10 patients receiving steel wire fixation, and 17 who received non-surgical treatment and who was designated as a control (conservative) group. Differences in clinical indices included the duration of surgery, blood loss, hospitalization, wound healing, hospitalization expenses, VAS scores, and patient satisfaction scores between the three groups was compared. The analysis of variance and t-test were used for quantitative variables, which were approximately normally distributed. Dichotomous data were compared used Pearson χ(2) or Fisher’s exact test, and a P value less than 0.05 was considered as statistically significant. RESULTS: All patients were cured, and there were no significant differences in general clinical features between the three groups (P>0.05). Thoracic deformity in the surgical groups was corrected anatomically and received better pain scores, while patients in the NI-TI memory alloy embracing fixator group showed advantages of bleeding and patient satisfaction (P

OBJECTIVES: Sternal fractures (SFs) are rare pathologies that mainly occur as a result of traffic accidents, which can cause mortality due to concomitant complications. In this study, we aimed to evaluate clinical processes and termination status of patients diagnosed with a SF in the emergency department. METHODOLOGY: Patients diagnosed with a SF in the emergency department during 8 years were retrospectively reviewed. The demographic and clinical characteristics of the patients were recorded, and standard data forms were created. RESULTS: In total, 128 patients were included in the study; 81 (63.3%) patients were male, and the mean age was 49.4 years. When the fracture mechanism was examined, car traffic accidents were the most common type and the cause of fracture in 85 (66.4%) patients. The most common thoracic pathology accompanying SFs was rib fractures (35.9%), and the most common extrathoracic pathology was cranial pathology (27.3%). Pericardial effusion was detected in 12 (9.4%) patients. Of the participating patients, one died and the others were hospitalized. CONCLUSION: Since SFs and associated complications can be life-threatening, emergency room physicians should consider it in the diagnosis. In particular, the necessary examinations and follow-up should be done to assess cardiac damage.

Surgical stabilization of patients with flail chest, dislocated serial rib and sternal fractures, posttraumatic deformities of the thorax, symptomatic non-unions of the ribs and/or sternum, and weaning failure to biomechanically stabilize the thorax and avoid respirator-dependent complications.Combination of clinically and radiologically observed parameters, such as pattern of thoracic injuries, grade of fracture dislocation, pathological changes to breathing biomechanics, and failure of nonsurgical treatment.Acute hemodynamical instability and signs of systemic infection.Detailed preoperative planning. Open, minimally invasive reduction and osteosynthesis using precontoured, low-profile locking plates and/or intramedullary splints. Careful reduction drilling/implantation of screws due to proximity of the pleura, lungs and pericardium.Weaning from respirator as early as possible and early therapy of pneumothorax perioperatively. Removal of implants usually not necessary.In a retrospective study, 15 polytraumatized patients with flail chest benefitted from an early interdisciplinary surgical treatment strategy within 24-48 h. Early osteosynthesis after severe thoracic trauma significantly reduced ventilator dependency and lowered the risk of pneumonia compared to patients who underwent surgery at a later time point. Patients with severe thoracic injury and life-threatening polytrauma, who meet the indication criteria for open reduction and surgical stabilization of the thorax, are in need of a throughly planned and interdisciplinary synchronized priorization and strategy. Longer intensive care unit stay, overall prolonged duration of admission in hospital, and higher level of respirator-associated complication should be expected in patients with life-threatening severe thoracic trauma (Abbreviated Injury Score (AIS) ≥ 3) compared to patients without thoracic trauma.OPERATIONSZIEL: Wiederherstellung einer normalen Atemmechanik und Vermeidung beatmungsassoziierter Komplikationen durch operative Stabilisierung eines instabilen Thorax bei dislozierten Rippenserien- und Sternumfrakturen, posttraumatischer Thoraxwanddeformierung, Weaning-Versagen und symptomatischen Rippenpseudarthrosen.Kombination mehrerer klinischer und radiologischer Parameter wie das Ausmaß der Rippenserien- und Sternumfrakturen, der Grad der Dislokation, pathophysiologische Veränderungen der Atemmechanik, Versagen eines konservativen Therapieansatzes.Akute hämodynamische Instabilität und Zeichen einer systemischen Infektion.Detaillierte präoperative Planung. Offene, möglichst minimalinvasive Reposition und winkelstabile Osteosynthese mit anatomisch vorgeformten Low-profile-Platten und/oder intramedullären Splints. Vorsichtige Repositionsmanöver und Einbringen der Implantate aufgrund enger Lagebeziehung zu Pleuraspalt, Lunge und Perikard.Möglichst frühzeitiges postoperatives Entwöhnen vom Respirator sowie frühzeitige Therapie eines perioperativen Pneumothorax. Eine Implantatentfernung ist in der Regel nicht notwendig.In einer retrospektiven Untersuchung profitierten 15 Polytraumapatienten mit instabilem Thorax von der frühen operativen Stabilisierung des Thorax innerhalb von 24–48 h und einer differenzierten, interdisziplinären Behandlungsstrategie. Beatmungsdauer und Pneumonierate waren in der Subgruppe der frühzeitig operierten signifikant niedriger als in der Gruppe der später operativ an der Thoraxwand stabilisierten Patienten. In den Subgruppen der lebensgefährlich Verletzten mit Thoraxtrauma (LVK-Thx und LOTX [LVK-Thx mit Osteosynthese am Thorax]) konnten eine längere Beatmungszeit, Intensivtherapie, Krankenhausverweildauer sowie eine erhöhte beatmungsassoziierte Komplikationsrate als in der Subgruppe der Schwerverletzten ohne Thoraxtrauma (AIS [Abbreviated Injury Scale] ≥ 3) gezeigt werden.

Background Western Trauma Association guidelines recommend admitting patients 65 years or older with two or more rib fractures diagnosed by chest radiograph to the intensive care unit (ICU). Increased use of computed tomography has led to identification of less severe, "occult" rib fractures. We aimed to evaluate current national trends in disposition of older patients with isolated rib cage fractures and to identify characteristics of patients initially admitted to the ward who failed ward management. Methods A retrospective cohort study of patients 65 years or older with isolated two or more blunt rib cage fractures using the 2010 to 2016 American College of Surgeons Trauma Quality Improvement Program database was performed. Ward failure was defined as patients initially admitted to the ward with subsequent need for unplanned ICU admission or intubation. Multivariable analyses were derived to study the independent predictors of failure of ward management. Propensity score matching sub-analysis was used to assess outcomes in patients admitted to the ward versus ICU. Results There were 5,021 patients included in the analysis. Of these patients, 1,406 (28.0%) were admitted to the ICU. On multivariable analysis, age was an independent predictor of ICU admission. Of the 3,577 patients admitted directly to the ward, 38 (1.1%) patients required unplanned intubation or ICU admission. Independent predictors of failure of ward management included chronic renal failure (odds ratio [OR], 7.20; p ≤ 0.001; 95% confidence interval [CI], 2.50-20.76), traumatic pneumothorax (OR, 8.70; p = 0.008; 95% CI, 1.76-42.93), concurrent sternal fracture (OR, 6.52; p ≤ 0.001; 95% CI, 2.53-16.80), drug use disorder (OR, 6.58; p = 0.032; 95% CI, 1.17-36.96), and emergency department oxygen requirement or oxygen saturation less than 95% (OR, 2.38; p = 0.018; 95% CI, 1.16-4.86). Mortality was higher in patients with delayed ICU care versus patients with successful ward disposition (21.1% vs. 0.8%; p Conclusion Our results suggest that the majority of isolated rib cage fractures in older patients are safely managed on the ward with exceedingly low ward failure rates (1.1%). Patients with failure of ward management have significantly higher mortality, and we have identified predictors of failing the ward. Level of evidence Therapeutic/Care Management, level IV; Prognostic III.

Chest wall trauma is commonly seen in patients admitted with both high and low-energy transfer injury. Whilst often associated with other injuries, it is also seen in isolation following simple falls in the older patient. Fixation of the chest wall grows in popularity as part of optimising patient care, particularly in terms of critical care stay. There is currently no description of the epidemiology of these injuries at a national level; nor has there been identification of factors that predict which of these patients undergoes surgery.The United Kingdom Trauma AuditResearch Network (TARN) database was analysed for the period April 2016 to 30th May 2017 for all adult patients presenting with a rib or sternal fracture. Characteristics of the population were described and a binary logistic regression model constructed to explore the influences of several explanatory variables on whether fixation was performed.Of 16,638 patients with chest wall trauma, 402 underwent fixation. Most chest wall injury patients were admitted under three specialties (orthopaedics (19.1%), emergency medicine (16.6%) and general surgery (17.7%)). The odds of fixation in unilateral flail chest was 107.51 (p0.0001), in bilateral flail or combined complexsternal fracture 47.63 (p = 0.007) and in 3 or more non-flail ribs 15.62 (p0.0001) when compared to less than three non-flail rib fractures. The odds of fixation was higher in an MTC (p0.0001) compared to a non-specialist hospital. The odds of fixation was higher in older patients (1.02, p0.0001) and the more severely injured (1.02, p0.0001).There is considerable variation nationally in the management of chest wall trauma. Injury type, patient age and care setting contribute to decision making in fracture fixation. This unique national dataset characterises for the first time the nature of contemporary chest wall trauma management and should help inform the design of future research on this topic.

Background: Massive anterior mediastinal hematoma due to chest compression during cardiopulmonary resuscitation is often caused by internal mammary artery injury. However, critical massive anterior mediastinal hematoma without damage to major blood vessels is extremely rare. We report a case of life-threatening anterior mediastinal hematoma without internal mammary artery injury during extracorporeal cardiopulmonary resuscitation. Case presentation: A 70-year-old man was transferred to our emergency department because of ventricular fibrillation arrest. Manual chest compressions and venoarterial extracorporeal membrane oxygenation were applied in the angiography room. Acute myocardial infarction was diagnosed, and percutaneous coronary intervention with stent placement was performed. Despite the establishment of venoarterial extracorporeal membrane oxygenation flow, the hemodynamics were unstable. Computed tomography revealed a massive anterior mediastinal hematoma compressing the right heart system and causing obstructive shock. Although local incision and anterior mediastinal hematoma drainage were tried for resolving obstructive shock, the patient's anemia did not improve, and there was still continuous hemorrhaging from the drainage tube. A median thoracotomy was then performed. There was no injury of the main trunk of the internal mammary artery but only hemorrhaging from the sternal fracture site. The patient's hemodynamics and anemia improved after hemostasis and gauze packing. Re-thoracotomy for gauze removal and sternal closure was performed three days post-hospitalization. Conclusions: It is important to consider hemorrhaging and unstable hemodynamics in patients who receive extracorporeal cardiopulmonary resuscitation. Therefore, a thoracotomy may take precedence over intravascular treatment for restoring hemostasis when there is no information regarding the bleeding site, such as the presence of extravasation.

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.

CASE An osteoporotic and kyphotic 72-year-old woman presented with sternal pain, severe chest instability, and shortness of breath secondary to a traumatic sternal nonunion resulting from an unhealed sternal fracture sustained in a motor vehicle accident several months earlier. One-year functional and radiographic outcomes are presented with complete resolution of symptoms. CONCLUSION Consideration for treatment with multiplanar, contourable, locked plating, augmented by autogenous graft, is warranted in the setting of sternal deformity and nonunion, particularly in the setting of osteoporosis and other sagittal plane deformity.

Cardiopulmonary resuscitation (CPR) contributes to significant chest wall injury similar to blunt trauma. With benefits realized for surgical stabilization of rib fractures (SSRFs) for flail injuries and severely displaced fractures following trauma, SSRF for chest wall injury following CPR could be advantageous, provided good functional and neurologic outlook. Experience is limited. We present a review of patients treated with SSRF at our institution following CPR.A retrospective analysis of patients undergoing SSRF following CPR was performed between 2019 and 2020. Perioperative inpatient data were collected with outpatient follow-up as able.Five patients underwent SSRF over the course of the 2-year interval. All patients required invasive ventilation preoperatively or had impending respiratory. Mean age was 59 ± 12 years, with all patients being male. Inciting events for cardiac arrest included respiratory, ventricular tachycardia, ventricular fibrillation, pulseless electrical activity, and anaphylaxis. Time to operation was 6.6 ± 3 days. Four patients demonstrated anterior flail injury pattern with or without sternal fracture, with one patient having multiple severely displaced fractures. Surgical stabilization of rib fracture was performed appropriately to restore chest wall stability. Mean intensive care unit length of stay was 9.8 ± 6.4 days and overall hospital length of stay 24.6 ± 13.2 days. Median postoperative ventilation was 2 days (range, 1-15 days) with two patients developing pneumonia and one requiring tracheostomy. There were no mortalities at 30 days. One patient expired in hospice after a prolonged hospitalization. Disposition destination was variable. No hardware complications were noted on outpatient follow-up, and all surviving patients were home.Chest wall injuries are incurred frequently following CPR. Surgical stabilization of these injuries can be considered to promote ventilator liberation and rehabilitation. Careful patient selection is paramount, with surgery offered to those with reversible causes of arrest and good functional and neurologic outcome. Experience is early, with further investigation needed.Therapeutic, Level V.

Blunt trauma may cause cardiac perforation requiring emergency surgical repair. Cardiac perforations are usually diagnosed by the presence of a pericardial effusion on echocardiography. However, cardiac perforations and pericardial effusions are sometimes too small to detect, resulting in underdiagnosis. In this case report, we describe a 22-year-old man who was involved in a traffic accident, admitted in a state of shock, and was initially treated for tension pneumothorax and liver and spleen injuries. His initial computed tomography scans revealed a small region of enhancement, corresponding to a small pericardial effusion, indicative of a cardiac perforation. Thus, an emergency median sternotomy was performed. He was diagnosed with perforation of the left atrial ear and right atrium, which were repaired surgically. His liver and spleen injuries were also treated, and the patient was discharged 44 days after admission. The detection of a small pericardial effusion on enhanced computed tomography enabled rapid diagnosis of a cardiac perforation and ensured emergency surgical repair could be performed as soon as possible. Learning objectives • To acknowledge the difficulty of diagnosing cardiac perforation in patients with pericardial injury, based on conventional signs of blunt cardiac injury, such as sternal fracture, serum cardiac enzymes, and hemothorax. • To recognize that a small pericardial effusion on enhanced computed tomography scans is an important finding that should raise suspicion of cardiac perforation and pericardial injury.

An 82‐year‐old man with untreated diabetes mellitus (DM) had anterior chest wall swelling and ulcers 2 years following blunt chest trauma. Contrast‐enhanced computed tomography revealed sternal fracture with osteolytic change and subcutaneous abscess. Blood and sternal cultures were positive for methicillin‐susceptible Staphylococcus aureus (MSSA). Transesophageal echocardiogram showed vegetation on the right coronary cusp and moderate aortic regurgitation. The patient received a diagnosis of infective endocarditis associated with chronic sternal osteomyelitis complicated by subcutaneous abscess because of MSSA. This case report showed that trivial trauma in patients with uncontrolled DM can cause chronic sternal osteomyelitis resulting in infective endocarditis.

In the case of isolated sternal fractures, conservative treatment with analgesics is common, but pain can persist for more than 10 weeks, which can significantly interfere with daily life. Ultrasound-guided paravertebral nerve block is reported to be a successful means of pain control in patients with chest wall injury or rib fracture.A 70-year-old female patient presented with anterior chest pain that had persisted for 2 weeks despite conservative treatment. Sagittal reconstruction chest computed tomography and sternum lateral oblique x-ray revealed an isolated sternal fracture. An ultrasound-guided bilateral paravertebral nerve block was performed for pain control. After performing the procedure twice at a 1-week interval, the patient reported complete pain alleviation, and no other problems were observed over the 3-month follow-up period.Ultrasound-guided bilateral paravertebral nerve block can help patients with isolated sternal fractures to manage pain and return to normal activities sooner than with oral analgesics.

Background Debate continues about the risks and benefits of systematic whole-body CT when no injury is clinically suspected. Risks of whole-body CT include high radiation exposure and iodine contrast agent, but its effectiveness in reducing mortality in low-risk motor vehicle crashes is unclear. Purpose To assess unsuspected injuries revealed at whole-body CT in patients following motor vehicle crash (MVC) meeting only kinetic elements of the Vittel criteria for the severity of trauma, with no evidence of trunk injury and a Glasgow Coma Scale score of 15. Materials and Methods This retrospective study included all consecutive adult patients who consulted an emergency department of a level 1 trauma center between August 2016 and July 2017 if they underwent whole-body CT for one or more kinetic elements of the Vittel criteria, had a normal examination of the trunk, and had a Glasgow Coma Scale score of 15. Data of the MVC mechanism and physical and biologic examinations were collected, as well as patient treatment data after whole-body CT. Whole-body CT examinations were read by two double-blinded readers to help detect unsuspected injuries. Results Ninety-three patients were included; 72 were men with a mean age of 30.8 years ± 12.0 (standard deviation). Sixty-nine patients were occupants of a car. Seventeen patients were hit by a car while on motorbikes, three while on bicycles, and four as pedestrians. Unsuspected injuries were depicted at 11 whole-body CT examinations: eight lung contusions, one acetabular fracture, one sternal fracture, and one adrenal hematoma. None of these injuries required a specific treatment. One patient with lung contusion of more than 30% of lung volume was followed without requiring further treatment. Conclusion In this population, whole-body CT did not lead to any change in patient treatment. These results suggest whole-body CT should not be systematically performed when no evidence of trunk injury is observed in patients following motor vehicle crash meeting only kinetic elements of Vittel criteria. © RSNA, 2019 See also the editorial by Munera and Durso in this issue.

Background Spine fractures combined with sternal injury are most commonly occur in the thoracic region. Lower cervical and thoracolumbar injuries have also been reported, especially for the patients with manubriosternal dislocation. The type of spine injury is easily recognized in initial presentation, but we may miss the sternal fracture and manubriosternal dislocation. Case presentation A 23-year-old male patient complained with chest, right ankle, and lumbar pain after a fall at ground level, with diagnosis of right distal tibial fracture, sternal fracture, calcaneus fracture, and L2 vertebral fracture. However, neurologically he was completely normal. He underwent the operation for his lower extremity and spine, but we missed his manubriosternal dislocation after discharged. After one month, he came to the clinic with complained of chest pain, the imaging exams showed anterior dislocation of manubriosternal joint. We chose conservative treatment for manubriosternal dislocation. He was followed up at monthly intervals and radiographs along with computerized tomography showed satisfactory in fracture healing of lumber and the sternal fracture. However, the manubriosternal dislocation was malunioned. The patient had appearance deformity of the manubriosternal joint. Conclusion This case supports the concept of the existence and clinical relevance of the thoracic cage theory, the thoracolumbar vertebrae should also be included in the thoracic cage theory.

Little evidence exist associating displaced sternal fractures with blunt cardiac injury (BCI), especially regarding the depth and severity of sternal fracture displacement and risk of BCI. The purpose of this study was to quantify sternal fracture severity by the degree of displacement and to evaluate the association of fracture severity with BCI.A single institution retrospective review was performed from 2011 to 2014. All adult patients with sternal fracture were identified from the trauma registry, and sternal fracture displacement was quantified as mild (0 mm,5 mm), moderate (≥5 mm,10 mm), or severe (≥10 mm). BCI was diagnosed according to standard AAST grading. Analysis was performed to assess the association of sternal fracture displacement with BCI, which was the primary outcome of interest.Two hundred thirty-five patients with sternal fractures were included in the study. Forty-five percentage of patients suffered a displaced fracture, and 42.6% were diagnosed with BCI. There was no difference in mean fracture displacement when compared to patients without BCI (2.4 versus 1.6 mm, P = 0.07). There was no significant increase in BCI with sternal fracture displacement when compared to patients with nondisplaced fractures (44.3% versus 41.1%, P = 0.62). Neither fracture displacement (OR 1.10, CI 95% 0.65-1.88) nor severe displacement (OR 2.34, CI 95% 0.64-8.54) was associated with significantly increased risk of BCI.There is no significant association between the depth of sternal fracture displacement and BCI. Further evaluation and management for BCI should be reserved in the absence of additional symptoms or findings.

Objective Sternal fracture may be associated with major and serious injuries. In this study, the complications associated with isolated sternal fracture in trauma patients are evaluated based on radiographic and cardiac findings. Methods This retrospective study was performed on patients with isolated sternal fractures admitted to the emergency department of (XXX) Madani Educational-Medical. Data regarding demographic information, mechanism of trauma, length of hospitalization, electrocardiography (ECG), cardiac enzyme, and chest radiography were recorded in the questionnaire for each patient. Results The mean age of patients 41.2 + 11.04 years and 63.9% were male. The most common cause of the trauma was car accidents in 41% (25 cases). The mean duration of hospitalization was 1.54 ± 0.90 days. The mechanism of trauma was not associated with x-ray and computed tomography findings, p = 0.53 and p = 0.86, respectively. ECG findings were significantly related to x-ray and computed tomography outcomes, p 0.5 cm and hematoma are likely to require cardiac consultation., Highlights • Sternal fracture may be associated with major and serious injuries. • Approximately, 10% of all trauma cases are blunt trauma. • Patients with isolated sternal fracture and hematoma are likely require cardiac consultation. • The type mechanism of trauma may not predict radiographic findings.

Background:Sternal fractures are rare, and they can be treated nonoperatively. Vertical sternal fractures have rarely been reported.Purpose:To describe the management and surgical treatment of a series of elite-level athletes who presented with symptomatic nonunions of a vertical sternal fracture.Study Design:Case series; Level of evidence, 4.Methods:Patients with an established symptomatic nonunion of a vertical sternal fracture, as diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI), underwent open reduction and internal fixation using autologous bone graft and cannulated lag screws. The patients were assessed preoperatively and at the final follow-up using the Rockwood sternoclavicular joint (SCJ) score; Constant score; and shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores. Bony union was confirmed on postoperative CT scan.Results:Five patients (4 men and 1 woman) were included; all were national- or international-level athletes (rugby, judo, show-jumping, and MotoGP). The mean age at surgery was 23.4 years (range, 19-27 years), the mean time from injury to referral was 13.6 months (range, 10-17 months), and the mean time from injury to surgery was 15.8 months (range, 11-20 months). The mean follow-up was 99.4 months (range, 25-168 months). There was a significant improvement after surgery in the mean Rockwood SCJ score (from 12.6 to 14.8 [ P < .05]), Constant score (from 84 to 96.4 [ P < .05]; 80% met the minimal clinically important difference [MCID] of 10.4 points), and QuickDASH (from 6.8 to 0.98 [ P < .05]; 0% met the MCID of 15.9 points). Four of the patients were able to return to sport at their preinjury level, and 1 patient retired for nonmedical reasons. All of the fractures had united on the postoperative CT scan. There were no postoperative complications.Conclusion:Vertical fractures of the sternum are very rare and tend to behave clinically like an avulsion fracture injury to the capsuloligamentous structure of the inferior SCJ. The requirement of advanced imaging to diagnose this injury means that the actual incidence and natural history are not known. For high-demand athletes, early identification, surgical reduction, and fixation are likely to achieve the best outcome.

Case We present the case of a 57-year-old woman who sustained a comminuted transverse sternal fracture that failed primary open reduction internal fixation (ORIF). The patient underwent staged nonunion reconstruction with a tricortical iliac crest bone graft and mesh plate. With 18 months of a sustained successful outcome, we propose a treatment strategy for a challenging clinical problem. Conclusion When primary ORIF fails, bone healing and resolution of a painful sternal nonunion can be effectively managed with a tricortical iliac crest in-lay autograft and locking mesh plate.

Traumatic cardiac injury is not rare. Especially cardiac contusion with sternal fracture due to blunt trauma in common. But cardiac rupture due to direct injury from fractured sternum in very rare. There were two case of cardiac injury supposed to be due to direct injury from fractured sternum. We operated immediately, so we could save these patients. Our cases show that it's rare but blunt trauma could make sternum fracture with direct injury to right side heart.

Author(s): Nasser, Keaton; Matsuura, Jaclyn; Diep, Jimmy | Abstract: Introduction: Blunt chest trauma and motor vehicle collisions are common presentations to the emergency department (ED). Chest pain in a trauma patient can usually and reasonably be attributed to chest wall injury, leading to a potential delay in diagnosis and treatment.Case Report: In this case report, we present a 52-year-old male who was brought to the ED with complaints of chest pain and pressure after a motor vehicle collision. He was subsequently found to have both a displaced sternal fracture and simultaneous acute myocardial infarction with 100% occlusion of the mid left anterior descending artery without dissection requiring stent placement.Conclusion: Chest pain after blunt cardiac trauma is a common complaint. While rare, acute myocardial infarction must be considered. Most injuries result as direct trauma to the artery causing either dissection or acute thrombosis resulting in a myocardial infarction as opposed to acute plaque rupture with thrombosis, as seen in this case.

Background Isolated sternal fracture, a benign injury, has been increasing in the pan-scan era, although one-third of patients with sternal fracture still has trouble with concomitant injury. The differentiation of these two entities is important to optimize patient management. Purpose To evaluate correlation between retrosternal hematoma and concomitant injury in patients with sternal fracture and to identify predicting factors for concomitant injury in sternal fracture. Material and Methods A total of 139 patients (84 men; mean age = 54.9 ± 15.3 years) with traumatic sternal fracture were enrolled in this study. We reviewed medical charts and multiplanar computed tomography (CT) images to evaluate cause, location, and degree of sternal fracture, retrosternal hematoma, and concomitant injury. Univariate and multivariate analysis were used to identify variables that were associated with concomitant injury. Results Concomitant injury on chest CT was observed in 85 patients with sternal fracture. Of the patients, 98 (70.5%) were accompanied by retrosternal hematoma. Multivariate analysis revealed that retrosternal hematoma (odds ratio [OR] = 5.350; P Conclusion Manubrium fracture and retrosternal hematoma portend a high risk of concomitant injury and indicate the need for further clinical and radiologic work-up.

Background Traumatic sternal fractures are rare injuries with little evidence supporting the best treatment strategy. This study assessed treatment outcomes from our level-I trauma centre. Methods A retrospective cohort study was conducted, including all sternal fracture patients admitted to our level-I trauma centre between 2007 and 2019. Patients with sternal fractures due to cardiopulmonary resuscitation, patients

The incidence of sternal fracture ranges from 3 to 8%. In more than half, they are associated with other organ trauma such as blunt cardiac injuries, rib, scapular or vertebral fractures. Hence, the presence of sternal fracture is considered a marker for significant transmission of energy. The management of isolated sternal fractures is usually non-operative with surgery reserved for displaced fractures or in cases of respiratory insufficiency. However, management may become challenging when they are associated with other significant trauma. We discuss a case of sternal fracture complicated by the presence of blunt cardiac injury, open pneumothorax, rib fractures, anterior flail chest and empyema.

A 63-year-old patient was admitted with a sternal fracture and mass. On evaluation, most of the body of the sternum had been destroyed by a tumor. Radical resection of the sternum was performed and part of the major pectoral muscles adherent to the sternal tumor was also resected. The chest wall defect was reconstructed with mesh, bone cement, and a titanium rib plate system. Reconstruction with this method seemed to be an appropriate procedure to prevent instability of the chest wall.

We report a rare case about a 60 years old Moroccan woman with a past medical history of gastrointestinal tuberculosis, admitted to the emergency department with fever, coughing, weight loss, Spontaneous sternum fracture, back and chest pain. A physical examination revealed diffuse bone pain on palpation. Laboratory testing revealed anemia at 9 g/dl, high serum viscosity (80 mm/h). C reactive protein at 100 mg/l. Serum protein electrophoresis showed monoclonal spike (30 g/dL) in the gamma zone. Serum immunofixation study revealed a IgG lambda monoclonal paraprotein. Serum free light chains (kappa/lambda ratio: 0,04). Total protein level (88g/L). 24-h proteinuria was negative, complete metabolic panel, blood calcium and serum creatinine were normal. Bone marrow aspiration was performed and showed mature and dystrophic plasma cells at 38 %. CT scan of the chest revealed left broncho pulmonary focus associated to a sternal fracture (A), mediastinal tissue mass of superior and posterior mediastinum of 30mm diameter (B), scanner-guided biopsy confirmed plasmocytoma, bronchoscopy with biopsy which objectified an inflammatory lesion. Hematological assessment concluded to mediastinal plasmocytoma with multiple myeloma Ig G Lambda. The Revised International Staging System is at 2. The patient received empirical antimicrobial therapy with good response, then she was treated with VTD protocol (Bortezomib, thalidomide and dexamethasone), achieving complete remission followed by autologous stem cell transplantation (C,D). Consolidation therapy and maintenance are planned to maintain remission.

Rib fractures are the most common form of blunt thoracic injury. Multiple rib fractures are an important indicator of trauma severity, with increased morbidity and mortality occurring with increasing numbers of rib fractures, especially in the elderly. Thoracic cage injuries may be associated with concomitant and potentially life-threating injuries. In the acute setting, correct recognition of the pattern, extent and severity of thoracic cage injuries, may aid in more accurate delineation of concomitant injuries.

Objectives: Clinical characteristics, follow-up and treatment outcomes of patients with isolated traumatic sternal fracture were presented and our clinical experiences on these patients were shared. Methods: Between January 2010 and December 2017, a total of 87 patients with isolated traumatic sternal fracture who were admitted to the emergency department and were hospitalized, were included in this observational cohort study. Medical data of these patients were collected from hospital records and then were retrospectively reviewed. Results: There were 65 (74.7%) male and 22 (25.3%) female patients. Mean age was 42.4 ± 13.7 years (range: 17-83). The most common etiological reason was traffic accident in vehicle. Sternal fractures were localized at corpus in 64 (73.6%) patients and at manubrium in 23 (26.4%) patients. The most common concomitant pathology was rib fracture with a ratio of 23% (20 patients). Mean length of hospital stay of patients was 3.1 ± 0.8 days. During the hospitalization period, no evidence of cardiac injury was observed in any patient. Conclusions: In view of rising healthcare costs and increasing demand for acute hospital and intensive care beds, it is crucial to determine hospitalization criteria for cases with traumatic sternal fracture. We believe that the hospitalization is not necessary in isolated traumatic sternal fractures where there is no other major injury.

Chronic nonunion of sternal fractures is typically treated by osteosynthesis plating with or without autologous bone grafting. Described here is a case of the successful use of teriparatide, a bone-forming drug currently used for the treatment of severe osteoporosis, in the healing of a sternal nonunion fracture occurring after blunt thoracic trauma.

Providing analgesia for patients with anterior rib and sternum fracture has been addressed from various types of modalities. Regional anesthesia via epidurals or peripheral nerve blocks, opiates, and other forms of multimodal pain regimens have been used. However, in the polytraumatic injury patient, positioning for an epidural may be problematic, and a predominantly opiate-based treatment plan may compromise respiratory status. In this case series, we describe the pectointercostal fascial block as another tool to treat patients with anterior rib and sternal fracture with polytraumatic injuries. All 3 of the block's successes were evident by improvement in the respiratory status of each patient.

Sternal fractures were first described in published literature in the 19th century as a complication of traumatic injury. Though sternal fracture and other sternal injuries have been described in trauma literature, there remains a paucity of literature with regards to sternal injury in sport. Sternal injury may include disruption at the body, manubrium and xiphoid process, or at associated sternoclavicular, manubriosternal, and xiphisternal joints. In the athlete it is imperative to evaluate sternal injury with consideration of potentially devastating cardiothoracic complications. Return-to-play protocols should be individualized, taking into account subjective history, objective physical examination and diagnostics, current clinical guidelines, and individual sport-specific considerations. The literature regarding sternal injury is reviewed, with emphasis on sport-specific pathology, management, and return to play.

The procedure introduced by Donald Nuss in 1997 for the treatment of pectus excavatum at the American Pediatric Surgical Association meeting has now been adopted by pediatric, thoracic, and plastic surgeons around the world. Rather than resection of the costal cartilages and sternal fracture, which had been standard practice for decades, he advocated using a metal bar to push the sternum into position. Reasoning that the chest wall of children is very flexible, he felt that resection was unnecessary. Since that time, medical centers from around the world have reported their experience with the procedure. There is now robust evidence of its safety and efficacy. As the Nuss procedure has become a standard treatment, indications for operation have expanded, and numerous modifications have been introduced. Some of these were intended to improve upon the original procedure, and others to adapt it to new circumstances, such as use in adults whose chest is not as flexible. This report reviews those modifications.

Background Scapular fractures have been traditionally taught to be associated with significant injuries and major morbidity. As we demonstrated with sternal fracture, pulmonary contusion, and rib fracture, increased chest computed tomography (CT) utilization and head-to-pelvis CT (pan-scan) protocols in blunt trauma evaluation, however, may diagnose minor, clinically irrelevant scapular fractures, possibly rendering previous teachings obsolete. Objectives The objectives were to determine the 1) percentages of scapular fractures seen on chest CT only (SOCTO) versus seen on both chest x-ray (CXR) and CT and of isolated scapular fracture (scapular fracture without other thoracic injuries); 2) frequencies of associated thoracic injury with scapular fracture; and 3) proportion of patients admitted, mortality, hospital length of stay, and injury severity scores (ISS), comparing four patient groups: scapular fracture, nonscapular fracture, scapular fracture SOCTO, and isolated scapular fracture. Methods We conducted a preplanned analysis of patients prospectively enrolled in the NEXUS Chest CT study at nine Level I trauma centers with the following inclusion criteria: age > 14 years, blunt trauma within 6 hours of ED presentation, and receiving chest imaging during ED trauma evaluation. Results Of 11,477 subjects, 4,501 (39.2%) patients who had both CXR and chest CT and 2.7% of these had scapular fractures; 60.3% of these were SOCTO and 23 (19.0%) were isolated scapular fracture. The most commonly associated thoracic injuries were rib fracture, pulmonary contusion, pneumothorax, and thoracic spine fracture and all injuries were more common in scapular fracture patients than nonscapular fracture patients. Although scapular fracture patients had higher admission rates (86.8% vs. 47.4%; difference in proportions = 39.4% [95% confidence interval {CI} = 32.8% to 44.1%]), ISS (21 vs. 5), and length of stay (9.2 days vs. 5.6 days; mean difference = 3.4 days [95% CI = 2.1 to 4.7 days]) than patients without scapular fracture, their hospital mortality was not significantly different (5.6% vs. 3.0%; difference in proportions = 2.6% [95% CI = -8.2% to 0.3%]; unadjusted odds ratio = 1.9 [95% CI = 0.9 to 4.2]). Patients with scapular fracture SOCTO and isolated scapular fracture had higher admission rates and median ISS than nonscapular fracture patients, but their mortality was similar. Conclusions Under current blunt trauma imaging protocols that commonly include chest CT, most scapular fractures are SOCTO and most are associated with other thoracic injuries. Although patients with scapular fracture SOCTO and isolated scapular fracture have higher admission rates and ISS than nonscapular fracture patients, their hospital mortality is similar.

Isolated sternal tuberculosis is a rarely described entity even in countries where tuberculosis is endemic. We report the case of 25 old years patient who presented with a chest wall mass. Imaging concluded to a (ring-enhancing hypodense soft tissue mass surrounding the sternum with sternal fracture). Malignancy was eliminated by a core needle biopsy. We noted clinical and radiological recovery with medical tuberculosis treatment. Neoplastic origin was removed by biopsy and anatomopathological study of the lesion.

Background Sternum fractures are mostly located on the sternal corpus, seldom on the manubrium. Fractures of the sternal manubrium are, however, more frequently associated with severe concomitant injuries of thoracic organs, and therefore deserve special attention. In addition, in its function as a capstone in between the anterior chest wall and the shoulder girdle, it is exposed to a multiplicity of forces. Therefore the questions arise what types of fractures are observed in today's clinical practice, how to classify them and which treatment options are available. This study reports on different types of fractures which involve the manubrium sterni. Methods Between January 2012 and October 2014, data was collected from all severely injured patients (ISS ≥16), which received a CT scan of the thorax in our Level-I-Trauma Center and retrospectively analyzed concerning sternal fractures. Fracture type, collateral injuries, age, and information about the circumstances of the accident were noted. Results Of 890 evaluable patients, 154 (17.3%) had a fracture of the sternum and 23 (2.6%) of the manubrium. Fractures of the manubrium appeared in following types: A-type-transverse fracture (n=11) in 1st intercostal space by direct blunt trauma or flexion of the torso with sagittal instability; B-type-oblique fracture (n=9) by seat belt injury with rotatory instability; C-type-combined, more fragmentary fracture (n=3) by direct blunt trauma with simultaneous flexion of the torso and multi directional instability. Fractures only little dislocation were treated conservatively, and unstable fractures were surgically stabilized (n=10). Conclusions In summary, three main types of fractures could be found. A-type fractures were stabilized with a longitudinal plate osteosynthesis and B-type fractures with transverse positioned plates. To treat complex C-type fractures, plates with a T- or H-form could be a good solution. Level of evidence: Level III retrospective prognostic cohort study.

Highlights • Mediastinal hematoma caused by sternal fracture leading to cardiac tamponade it’s a rare presentation. • CT Scan it’s an effective method to diagnose mediastinal hematoma. • High clinical suspicion of extra pericardial tamponade is required when sternal fracture associated with mediastinal hematoma. • The best management for mediastinal hematoma its urgent evocation of the hematoma to decrease the pressure on the heart., Introduction Cardiac tamponade typically results from fluid or gas collection in the pericardial space leading to impairment in the cardiac function. Presentation of case A 34 years old male patient presented to the ER after a fall from height. X-rays were done which showed no hemothorax or pneumothorax and multiple stable pelvic fractures. Computed tomography (CT) scan for trauma was done after stabilizing the patient and showed sternal fracture with a huge retrosternal hematoma. The patient was intubated immediately, and an Echocardiogram was ordered along with preparation to go to the operation room urgently due to high suspicion of a rare case of cardiac tamponade. but the patient had cardiac arrest and couldn't be revived despite the CPR effort. Discussion This is a very unusual presentation of cardiac tamponade, mediastinal hematoma leading to extra pericardial tamponade. CT scan is an effective method to diagnose extra pericardial tamponade. In addition, to the high clinical suspicion is required. The sole treatment of mediastinal hematoma is an urgent evacuation. Conclusion A careful assessment with high clinical suspicion along with CT Scan is the best way to diagnose extra pericardial tamponade cause by sternal fracture.

Objective Traumatic sternal fractures are injuries most commonly resulting from a direct blow to the anterior chest wall or forced deceleration. The purpose of this review is to define the clinical significance of these injuries, outline their initial evaluation and work up, and review current treatment strategies available and their outcomes. Background The diagnosis of traumatic sternal fractures has seen a recent rise, largely due to the increased access to computed tomography (CT) scan. Currently, there are no published guidelines to make recommendations on operative fixation for sternal fractures. This is probably related to the lack of evidence in published literature along with patient heterogeneity. Methods We conducted a non-systematic review of the English literature published from January 2000 to December 2020, including meta-analyses, systematic reviews, case series and case reports regarding the diagnosis, treatment, and complications of traumatic sternal fractures. We critically analyzed the available evidence to provide an overview of the treatment and clinical outcomes of traumatic sternal fractures. Conclusion Isolated sternal fractures are commonly benign injuries that can be managed conservatively in an outpatient setting. Polytrauma patients with sternal fractures should be carefully screened for possible associated injuries. Surgical stabilization of sternal fractures is feasible and safe, and should be considered in unstable fractures, severe displacement, symptomatic malunion or non-union.

Purpose The surgical management of the patients with traumatic sternal fractures remains controversial. The aim of this study was to evaluate the effectiveness of an early surgical reconstruction of a displaced sternal fracture utilizing longitudinal rigid polymer fixation in the settings of an acute chest trauma. Methods To perform the sternal fixation, we utilized a longitudinal rigid plating system. The plate is made of polyether ether ketone (PEEK), an organic thermoplastic polymer. Results We used the entire length of the plate on each side of the fracture, secured in multiple places with 6-8 screws. Once the plates have been fully secured we tighten all the screws with a screwdriver. We demonstrated that the method minimizes pain and prevents the development of pulmonary complications. Conclusion This technique provides cosmetically acceptable results, minimizing risk of sternal nonunion, and decreases length of hospitalization.

Background The fracture of ribs is a common injury presenting to trauma centers and hospitals. Along the years, a lot of methods have been introduced to stabilize the rib and sternal fractures, as most of studies reported that the treatment of these cases is warranted. In spite of the large number of methods for fixation introduced; no definitive method has been presented yet. Methods From July 2015 to November 2016, the data of 30 patients with rib or sternal fractures or both who fulfilled the inclusion criteria were collected prospectively. Those patients were assigned into two groups; (group A) the fractures were fixed by plates and (group B) were fixed by stainless steel wires. The choice of method of fixation depended on surgeon's experience. The variables evaluated included stability of chest wall, intensive care unit stay, hospital stay and ventilator days. Results The chest wall stability in (group A) was achieved in 100% of the patients, while in (group B) it was achieved in 60% of patients. Intensive care unit stay for group A was 9 ± 4.37 days and for group B 13.8 ± 7.61 (p = 0.031). Hospital stay for group A was 11.6 ± 5.27 days and for group B 17.1 ± 6.77 (p = 0.021). Ventilator days for (group A) were 6.38 ± 3.83 days, while in (group B) 10.3 ± 8.82days, however this difference was statistically insignificant (p = 0.129). Conclusions Plating of rib and sternal fractures had better outcome than wiring, regarding better chest wall stability and restoration of chest contour; also it had shorter intensive care unit, hospital and ventilator days.

Background Ventilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. Methods We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score. Results Forty-six patients (45.5%) had at least 1 episode of VAP, 10 (21.7%) of whom died in the ICU. Of the 55 (54.5%) patients who did not have pneumonia, 9 (16.4%) died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029). Conclusion Severe pulmonary contusion (pulmonary lung contusion score 6-12) is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.

Chest wall injuries are common in blunt trauma and are associated with significant morbidity and mortality, that increase with age and number of rib fractures. Blunt chest traumas may injure every bone of the thorax. Management of chest wall injuries often requires a multidisciplinary approach, focusing on three basic principles: pain management, management of pulmonary dysfunction, and in some cases surgical fixation.

Background and aims A case report of the use bilateral subpectoral nerve catheters in a 57-year-old patient with severe acute pain secondary to a traumatic sternal fracture. the pain was opioid-resistant and unchanged by systemic analgesia. It was preventing the patient from mobilizing, deep breathing and coughing. Methods Consent was obtained. He was positioned supine. Aseptic technique was adhered to. a SonoSite® ultrasound high frequency linear probe was placed 2cm lateral to the sternum in the parasagittal plane and a Pajunk E-Cath nerve catheter needle was inserted in plane from caudal to cephalad in the fascial plane between pectoralis major and external intercostal muscle. 10 ml of 0.25% levobupivacaine was injected bilaterally, and the catheters were subsequently topped up every 12 hours. Results Within 5 minutes of a single dose of local anaesthetic the patient was pain free, able to deep breath, cough and mobilise. He was discharged home after 3 days of treatment. Conclusions In patients with isolated sternal fractures, severe pain is the most frequently reported complaint and this can lead to further complications, such as hospital-acquired pneumonia. Furthermore, high dose opioid therapy can lead to multiple adverse events and is often ineffective in chest wall fractures. This case highlights that subpectoral nerve catheters used in the management of sternal fractures can reduce pain. Further research if required to determine its role in reducing opioid-associated complications, incidence of pneumonia and inpatient length of stay.

Background The risk of cardiac injury in blunt thoracic trauma is quite rare, occurring in only 0.1% of patients. The least common cardiac injury is coronary artery dissection. Most cardiac injuries result from high-energy mechanisms such as motor vehicle collisions. Even low-mechanism injuries that have been reported involved rapid deceleration. Case Report We present a case of traumatic coronary artery dissection that resulted from a low-energy blunt thoracic injury with no rapid deceleration. This patient had no other associated thoracic injuries, such as rib fractures or sternal fracture. Following presentation, our patient twice deteriorated into ventricular fibrillation and was successfully resuscitated each time. The coronary lesion was successfully stented and the patient was eventually discharged home. Why Should an Emergency Physician be Aware of This? This case underscores the importance of maintaining a high level of suspicion for coronary artery dissection even in low-energy mechanisms. An electrocardiogram should be obtained early, even in low-energy mechanisms. While patients with traumatic cardiac injuries will commonly present with other injuries, such as rib fractures, the absence of these injuries does not rule out cardiac injury.

Sternal fracture is a common complication of chest trauma but has a low incidence. Various treatments have been developed to reconstruct sternal fractures. Among these approaches, analgesia, corset fixation, and open reduction with plate internal fixation have been suggested. The use of newly developed minimally invasive plate osteosynthesis is a feasible method. In this study, we report a case involving a 54-year-old man with a sternal fracture accompanied by bilateral pleural effusion and a small amount of right-sided pneumothorax. The patient was treated with minimally invasive plate osteosynthesis. The operation was successful and the postoperative recovery was good. No pneumothorax or complications such as chest pain, paresthesia, or wound infection were observed at the 1-year follow-up visit. Additionally, the bilateral pleural effusion had been completely absorbed. The incision in the lower chest was aesthetic and minimally traumatic. This case describes a novel method for internal fixation of sternal fractures.

The treatment of thoracic spine (TS) fractures with additional sternal fractures compared to TS fractures without sternal fractures is discussed controversionally, because in some studies it was stated that sternal fractures decrease the thoracic stability. We hypothesized that both types of fractures can be treated the same way by posterior stabilization alone. A total number of 69 patients with thoracic fractures, with or without additional sternal fractures, were examined, regarding the angle of kyphosis after fracture, postoperatively and after 6 and 12 months. We also recorded the outcome using the Odom’s score and the time until patients returned to work and the activity level. It was found that the angle of kyphosis was nearly physiological after stabilization in both groups and a loss of reduction after 1 year was also comparable, either in the patients suffering from the additional sternal fracture or not. In addition, the Odom’s score and the time until return to work and the activity level were comparable in both groups. We did not find any arguments to preserve additional anterior stabilization or reasons for different treatment strategies either additional sternal fractures occur in thoracic spine fractures or not.