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Introduction: Sternal fractures are rare, causing significant pain, respiratory compromise, and decreased upper extremity range of motion. Sternal fixation (SF) is a viable treatment option; however, there remains a paucity of literature demonstrating long‐term benefits. This study examined long‐term outcomes of SF, hypothesizing they have better long‐term quality of life (QoL) than patients managed nonoperatively (NOM). Methods: This was a survey study at our level 1 academic hospital. All patients diagnosed with a sternal fracture were included from January 2016 to July 2021. Patients were grouped whether they received SF or NOM. Basic demographics were obtained. Three survey phone call attempts were conducted. The time from injury to survey was recorded. Outcomes included responses to the QoL survey, which included mobility, self‐care, usual activities, chest pain/discomfort, and anxiety/depression. The survey scale is 1–5 (1 = worst condition possible; 5 = best possible condition). Patients were asked to rate their current health on a scale of 0–100 (100 being the best possible health imaginable). Chi square and t‐tests were used. Significance was set at p < 0.05. Results: Three hundred eighty four patients were surveyed. Sixty nine underwent SF and 315 were NOM. Thirty‐eight (55.1%) SF patients and 126 (40%) NOM patients participated in the survey. Basic demographics were similar. Average days from sternal fracture to survey was 1198 (±492) for the SF group and 1454 (±567) for the NOM group. The SF cohort demonstrated statistically significant better QoL than the NOM cohort for all categories except anxiety/depression. Conclusion: SF provides better long‐term QoL and better overall health scores compared to NOM. [ABSTRACT FROM AUTHOR]

Background and Objective: This study investigated the accuracy of portable ultrasonography in the diagnosis of traumatic thoracic lesions (hemothorax, pneumothorax, contusions and fractures) compared to Computed Tomography scan (CT-scan). Materials and Methods: This descriptive-analytical cross-sectional study was carried out on 50 patients with thoracic trauma to assess the diagnostic value of portable ultrasonography compared to CT scan. First, ultrasonography of the lungs and CT scan of the chest were performed. Then, the sensitivity, specificity, and positive and negative predictive values were investigated to examine the accuracy and precision of ultrasonography compared to CT scan. Results: In this study, the sensitivity, specificity, and positive and negative predictive values of ultrasonography for detecting thoracic lesions and complications following trauma were 56.82%, 100.0%, 100%, and 91.52%, respectively, with a diagnostic accuracy of 92.37%. Conclusion: The findings of the present study suggested that in the initial evaluation of patients with traumatic thoracic injuries, ultrasonography, in addition to being an accessible, simple, low-cost and feasible method for all patients, has a high diagnostic value, especially in diagnosing pneumothorax and sternum fracture. [ABSTRACT FROM AUTHOR]

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In uncomplicated sternal fractures, one of the first priorities is to treat pain in order to avoid secondary complications due to hospital admission or reduced mobility. We wanted to study the safety and the efficacy of ultrasound-guided superficial parasternal intercostal plane (SPIP) block in pain control in these kinds of patients in the emergency department (ED). SPIP block has proven to be a safe and practical technique in pain control in the operatory room e.g. for heart surgery but its use in the emergency setting is poorly reported. Here we present two cases in which SPIP block was effectively and safely used to treat pain secondary to sternal fractures, allowing a rapid discharge from ED (case 2) or an easier pain control in an admitted patient (case 1). We think that SPIP block should be taken into consideration in case of sternal fractures non responsive to conventional analgesia., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Cardiac tamponade is a condition with impaired cardiac function by acute fluid accumulation in the pericardium. Extracardiac masses, such as a mediastinal hematoma, can also cause cardiac tamponade. We report a case of impending extrapericardial cardiac tamponade secondary to traumatic sternal fracture with expanding mediastinal hematoma. An 82-year-old male presented to the emergency department after a motor vehicle accident. On arrival, he was hemodynamically stable. An electrocardiogram (ECG) revealed normal sinus rhythm and sporadic premature ventricular complexes (PVCs), which had been documented in his past Holter ECGs. Initial evaluation with a focused sonographic assessment for trauma was negative. However, subsequent computed tomography (CT) showed a small retrosternal hematoma with a sternal fracture and a rib fracture. On day 4, repeated ECG demonstrated more frequent PVCs, a change in morphology, and episodes of non-sustained ventricular tachycardia. Follow-up CT and echocardiogram showed an expanding hematoma and compressed right ventricle. Cardiology and Surgery were consulted, and urgent surgical drainage of the hematoma was performed. The patient was discharged without complications on day 17. An expanding mediastinal hematoma after blunt chest trauma can cause extrapericardial tamponade. In this case, the hematoma caused a change in ECG and increased ventricular ectopy, which served as a critical indicator for successful surgical intervention before circulatory collapse occurred. Telemetry and repeat ECGs should be performed for the first few days following significant chest trauma. This case highlights the utility of continuous ECG monitoring, which provides clinicians with timely recognition of cardiac functional changes and a beneficial indication for appropriate intervention., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Huh et al.)

• Rib and sternal fractures present serious challenges to trauma clinicians and are associated with significant morbidity and mortality. • Overall, the age-standardised incidence rate of sternal and rib fractures in England was higher in males than females from 1990–2019. • An overall decrease in incidence rate was observed among males, whereas an overall increase in incidence rate was observed among females. • Variation in diagnostic and management strategies may account for the observed sex disparities and regional differences in incidence. • The increasing injury burden is suggestive of the importance of clear clinical guidance and sustained financial investment in trauma infrastructure. Fractures of the ribs and sternum are associated with significant morbidity and mortality. Characterization of the injury burden across England is necessary to inform and evaluate developments in trauma care and infrastructure, however is yet to be comprehensively undertaken. Therefore, the aim of this study was to describe trends in the incidence of sternal and rib fractures across England between 1990 and 2019. Age-standardised incidence rates (ASIRs) for rib and sternal fractures in males and females were extracted from the 2019 Global Burden of Disease (GBD) study by all causes, falls and road traffic collisions for 9 sub-regions of England. Temporal trends within the study period were analysed using Joinpoint regression analysis. The overall ASIRs in England in 2019 were 30.34/100,000 and 46.02/100,000 for females and males, respectively. Between 1990 and 2019, the estimated overall percentage change across England was +0.20 % among females and -7.05 % among males. A statistically significant increase in ASIR was observed in all 9 sub-regions of England among females from 2014–2019 (p <0.001). Among males, a statistically significant increase in ASIR was observed in 7 of the 9 regions from 2014–2019 (p <0.001) and in the remaining 2 regions from 2015–2019 (p <0.001). Increasing ASIRs of rib and sternal fractures were observed among females and decreasing ASIRs among males, with overall ASIRs higher among males. Developments in trauma infrastructure and associated variations in diagnostic and management strategies over the observation period likely contribute to changes in the national injury burden. The findings are suggestive of the importance of ongoing financial investment in trauma infrastructure and of clear clinical guidelines to manage an increasing national injury burden. [ABSTRACT FROM AUTHOR]

Objectives: Isolated sternal fractures are rare pathologies that rarely require surgical fixation. Although different fixation techniques are used, it is routinely performed under general anaesthesia. In our study, we aimed to share the details of the awake sternal fixation technique performed in our clinic and to compare the early results with sternal fixation methods performed under general anaesthesia., Methods: Between January 2009 and January 2023, 129 patients who were diagnosed with sternal fracture and who underwent investigations and follow-up in our clinic were evaluated retrospectively. Thirteen patients who underwent surgical fixation for isolated sternal fracture were included in the study. Patients were categorized according to fixation and anaesthetic technique; group 1: fixation with steel wire under general anaesthesia (n = 4), group 2: fixation with titanium plate-screw under general anaesthesia (n = 4) and group 3: fixation with awake titanium plate-screw with parasternal intercostal plane block (n = 5). Demographics, surgical indication, radiological findings, surgical incision, surgical time and hospital stay were statistically compared., Results: The mean age of the patients included in the study was 55.15 ± 15.01 years and 84.6% (n = 11) were male. The most common reason for fixation was displaced fracture (53.8%). Fixation surgery was performed due to pain in 30.8% (n = 4) and non-union in 15.4% (n = 2) of the fractures. The mean duration of surgery were 98.75 ± 16.52, 77.5 ± 35 and 41 ± 14.74 min, respectively. Duration of surgery was significantly lower in group 3 compared to the other groups (P = 0.012). The hospital stay duration for group 1 was 6 days, group 2 was 4 days and group 3 was 1 day. A notable difference was observed among all groups (P = 0.019)., Conclusions: Awake sternal fixation technique with titanium plate-screw system under superficial parasternal intercostal plane block is an easy and effective method for surgical treatment of isolated sternal fractures. This technique showed a direct positive effect on the duration of surgery and hospital stay., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

Traumatic injuries of the thorax can entail thoracic wall instability (flail chest), which can affect both the shape of the thorax and the mechanics of respiration; however, so far little is known about the biomechanics of the unstable thoracic wall and the optimal surgical fixation. This review article summarizes the current state of research regarding experimental models and previous findings. The thoracic wall is primarily burdened by complex muscle and compression forces during respiration and the mechanical coupling to spinal movement. Previous experimental models focused on the burden caused by respiration, but are mostly not validated, barely established, and severely limited with respect to the simulation of physiologically occurring forces. Nevertheless, previous results suggested that osteosynthesis of an unstable thoracic wall is essential from a biomechanical point of view to restore the native respiratory mechanics, thoracic shape and spinal stability. Moreover, in vitro studies also showed better stabilizing properties of plate osteosynthesis compared to intramedullary splints, wires or screws. The optimum number and selection of ribs to be fixated for the different types of thoracic wall instability is still unknown from a biomechanical perspective. Future biomechanical investigations should simulate respiratory and spinal movement by means of validated models., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)