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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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Sternal fractures are rare and are typically caused by major trauma such as motor vehicle collisions. However, sternal insufficiency fractures can occur with minimal to no trauma in patients with exaggerated thoracic kyphosis from multiple thoracic compression fractures, especially in the setting of osteoporosis. We describe a case of a sternal insufficiency fracture that presented as chest pain resembling a myocardial infarction. As sternal insufficiency fractures may vary in clinical presentation, this case demonstrates that radiologists should carefully evaluate the sternum, especially when risk factors are present. Furthermore, awareness and identification of these fractures can prevent unnecessary cardiac workups.

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.

Key Clinical Message: Sternal fractures are commonly due to blunt force trauma and reduction is an invasive surgical procedure typically indicated for refractory pain sternal instability. There were various modalities used for treatment and fixation of the sternal fractures. Sternal displacement fractures are traumatic injuries that may require surgical correction. [ABSTRACT FROM AUTHOR]

Introduction: Sternal fractures (SF) are uncommon injuries usually associated with a significant mechanism of injury. Concomitant injury is likely, and a risk of mortality is substantial. Aim: Our aim in this study was to identify the risk factors for mortality in patients who had sustained sternal fractures. Methods: We conducted a single centre retrospective review of the trust's Trauma Audit and Research Network Database, from May 2014 to July 2021. Our inclusion criteria were any patients who had sustained a sternal fracture. The regions of injury were defined using the Abbreviated Injury Score. Pearson Chi-Squared, Fisher Exact tests and multivariate regression analyses were performed using IBM SPSS. Results: A total of 249 patients were identified to have sustained a SF. There were 19 patients (7.63%) who had died. The most common concomitant injuries with SF were Rib fractures (56%), Lung Contusions (31.15%) and Haemothorax (21.88%). There was a significant increase in age (59.93 vs 70.06, p =.037) and admission troponin (36.34 vs. 100.50, p =.003) in those who died. There was a significantly lower GCS in those who died (10.05 vs. 14.01, p <.001). On multi regression analysis, bilateral rib injury (p = 0.037, OR 1.104) was the only nominal variable which showed significance in mortality. Conclusion: Sternal Fractures are uncommon but serious injuries. Our review has identified that bilateral rib injuries, increase in age, low GCS, and high admission troponin in the context of SF, were associated with mortality. [ABSTRACT FROM AUTHOR]

Chest pain is a frequent complaint among patients in both the emergency department and outpatient clinics. Several urgent cardiac conditions, including acute coronary syndrome, aortic dissection, and pericarditis, must always be ruled out through meticulous clinical evaluations. Chest pain due to spontaneous sternal fractures is relatively common in patients diagnosed with multiple myeloma. Nevertheless, the clinical manifestation is usually subtle and progressive. In this particular case, the patient’s primary symptom during the treatment of multiple myeloma was acute chest pain, resulting from a spontaneous sternal fracture. The patient received pain management and chemotherapy for multiple myeloma, which effectively alleviated the pain. [ABSTRACT FROM AUTHOR]

Introduction: The Arbeitsgemeinschaft für Osteosynthesefragen (AO) foundation along with the Orthopaedic. Trauma Association (OTA) introduced a new classification for sternal fractures in 2018 aiming to provide greater uniformity and clinical utility for the surgical community. A previous validation study identified some critical issues such as the differentiation between type A and B fractures and localization of the fracture either in the manubrium or in the body. Due to the moderate agreement in inter- and intra-observer variability, some modifications were proposed in order to improve the performance of the classification. The aim of this study was to re-assess the inter- and intra-observer variability after adding modifications to the classification. Our hypothesis was that a significative improvement of inter- and intra-observer variability could be achieved. Material and methods: Twenty computed tomography (CT) scans of patients with sternal fractures were analyzed by six. Junior and six senior surgeons independently. Two assessments were performed with an interval of 6 weeks. The kappa (K) value was calculated in order to assess inter- and intra-observer variability. Results: The overall mean kappa value for inter-observer variability improved from 0.364 to 0.468 (p < 0.001). Inter-observer variability mean for location was 0.573 (SD 0.221) and for type was 0.441 (SD: 0.181). Intra-observer variability showed a mean of 0.703 (SD: 0.153) with a statistic significant improvement when compared to the previous study (mean 0.414, SD: 0.256, p < 0.001). Conclusions: By modifying the AO/OTA classification of sternal fractures, the inter- and intra-observer variability improved and now shows moderate to substantial agreement. [ABSTRACT FROM AUTHOR]

Key Clinical Message Sternal fractures are commonly due to blunt force trauma and reduction is an invasive surgical procedure typically indicated for refractory pain sternal instability. There were various modalities used for treatment and fixation of the sternal fractures. Sternal displacement fractures are traumatic injuries that may require surgical correction.

Abstract Background Falls are a common cause of emergency department (ED) visits for the older population. If osteoporosis is present, even falls from standing height can lead to unusual fractures normally associated with high-energy trauma. In this report, we analyze a rare case of an isolated sternal fracture with an unusual mechanism of injury. Our discussion aims to improve care for older adults with fall-related fractures. Case presentation An 86-year-old female presented in the ED of our hospital with a complaint of chest pain. She recalled a fall at home the previous day and described how her fist was impacted between the floor and her chest. A physical examination revealed local tenderness in the mid-chest. A lateral chest x-ray indicated a sternal fracture, and a chest computed tomography scan ruled out concomitant injuries. There were no acute changes on her electrocardiogram (ECG). Conservative outpatient treatment was started, and referrals were made with a recommendation to initiate fall prevention measures and osteoporosis screening in primary health care. Conclusions Geriatric patients can present in the ED with a rare sternal fracture even after only a minor chest trauma. Appropriate imaging and an ECG are warranted to exclude life-threatening additional injuries. An in-depth physical examination and an understanding of the exact mechanism of injury are important to avoid missing fractures in unexpected locations. Modern ED physicians could have an important role in the secondary prevention of fall-related fractures for geriatric patients.

A previously healthy, 4-year-old boy visited our emergency department due to chest pain after a fall from a skate scooter. Physical examination revealed tenderness over the sternal body. Point of care ultrasound (POCUS) of the sternum demonstrated a discontinuation of a hyperechoic structure of the sternal cortex, suggesting a sternal fracture. POCUS did not detect intraperitoneal fluid, pericardiac effusion, or pneumothorax. Plain radiograph confirmed the diagnosis of isolated sternal fracture and the patient was discharged with conservative treatment. POCUS was useful not only in diagnosing a sternal fracture but also to rule out concurrent injuries.

Screening for blunt cardiac injury (BCI) includes obtaining a serum troponin level and an electrocardiogram for patients diagnosed with a sternal fracture. Our institution has transitioned to the use of a high sensitivity troponin I (hsTnI). The aim of this study was to determine whether hsTnI is comparable to troponin I (TnI) in identifying clinically significant BCI. Trauma patients presenting to a level I trauma center over a 24-mo period with the diagnosis of sternal fracture were screened for BCI. Any initial TnI more than 0.04 ng/mL or hsTnI more than 18 ng/L was considered positive for potential BCI. Clinically significant BCI was defined as a new-bundle branch block, ST wave change, echocardiogram change, or need for cardiac catheterization. Two hundred sixty five patients with a sternal fracture were identified, 161 underwent screening with TnI and 104 with hsTnI. For TnI, the sensitivity and specificity for detection of clinically significant BCI was 0.80 and 0.79, respectively. For hsTnI, the sensitivity and specificity for detection of clinically significant BCI was 0.71 and 0.69, respectively. A multivariate analysis demonstrated the odds ratio for significant BCI with a positive TnI was 14.4 (95% confidence interval, 3.9-55.8, P < 0.0001) versus an odds ratio of 5.48 (95% confidence interval 1.9-15.7, P = 0.002) in the hsTnI group. The sensitivity of hsTnI is comparable to TnI for detection of significant BCI. Additional investigation is needed to determine the necessity and interval for repeat testing and the need for additional diagnostic testing. [ABSTRACT FROM AUTHOR]

Background: Establishing adequate analgesia for rib and sternal fractures remains a challenge due to the prolonged nature of the associated pain. Historically, cryoneurolysis has demonstrated beneficial in treating chronic pain, and the recent development of hand-held devices has allowed its functionality to expand into the management of acute pain. Case: We present a polytrauma patient with sternal and multiple rib fractures that underwent ultrasound-guided intercostal cryoneurolysis at bedside, resulting in significant analgesia lasting several weeks and improving mobilization. This is the first report of the utilization of cryoneurolysis to treat acute sternal fracture pain. Conclusion: The most common sternal fracture pattern is transverse which only requires treatment of four intercostal nerves, making cryoneurolysis feasible in trauma centers. This portable, minimally invasive, and low risk technique has the added benefits of reducing opioid requirements, decreasing length of hospital stay, and improving mobility in polytrauma patients.

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.)

Traumatic sternal fractures are rare injuries. The most common etiologic cause is a blunt injury to the anterior chest wall. When an individual is exposed to serious trauma, the first goal of treatment is to preserve the patient's life and avoid multiple organ failures and other complications through rapid and effective intervention. The aim of this study was to statistically analyze the trauma scores and sternal fracture localizations that were calculated following the analysis of the data of the patients who were admitted to the emergency department after blunting thoracic trauma. It is planned to compare the obtained data with the literature. The trauma scores of the patients were determined through the implementation of the anatomical scoring systems, the Abbreviated Injury Scale (AIS), and the Injury Severity Score (ISS), which are calculated by squaring the AIS scores of the three most severely injured body systems. Out of our 96 patients, 65 were male and 31 were female. In the statistical analysis performed between the sternal fracture localization that occurred after trauma and the ISS, the highest scores were found in mixed type fractures, with a mean value of 36.77±9.62 (p=0.001). Statistical analyses of the relationship between ISS interval values, sternal fracture localization and the number of rib fractures accompanying the sternal fracture were found to be significant (p=0.035, p<0.001). It is thought that determining the probability of mortality by calculating the trauma score (especially ISS) in patients with sternal fractures as a result of high-energy traumas will contribute significantly to the literature. [ABSTRACT FROM AUTHOR]

Purpose: Sternal fractures (SF) are commonly associated with other injuries and their incidence is on the rise. The aim was to evaluate injury characteristics and outcomes in patients with all types of SF after blunt trauma. Methods: Retrospective analysis of 380 SF patients from two Level 1 trauma centers was performed. Patients were compared in various combinations: geriatric versus non-geriatric, isolated sternal fractures (ISF) versus combined sternal fractures (CSF), sternal body versus manubrium, displaced versus non-displaced, and with retrosternal hematoma versus without. Analyzed variables included: age, gender, race, comorbidities, mechanism of injury (MOI), injury severity score (ISS), Glasgow Coma Score (GCS), type and location of SF, concomitant fractures of ribs, vertebrae, clavicles and scapulae, co-injuries, rates of surgical stabilization, mechanical ventilation requirements, intensive care unit (ICU) admission, ICU length of stay (ICULOS), hospital LOS (HLOS), complications, and mortality. Results: ISF constituted 17.9% of all patients with no mortality. CSF patients constituted 82.1%, had more ICU admissions, longer ICULOS/HLOS and 9.3% mortality (all p < 0.001). Geriatric SF had more concomitant rib fractures and 12.9% mortality. Concomitant fractures of ribs were present in 56.7% and had higher ICU admissions, ICULOS and complications compared to SF patients with concomitant vertebrae fractures diagnosed in 38.2%. Conclusion: SF are present in 2.1% of admissions to trauma centers. Geriatric patients account for half of SF patients and have higher mortality. Concomitant fractures of ribs are present in half and vertebrae fractures in one-third of the SF patients. CSF portend higher mortality and pulmonary co-injuries. The high incidence of concomitant rib and vertebra fractures requires additional diagnostic and treatment considerations. [ABSTRACT FROM AUTHOR]

Background: Falls are a common cause of emergency department (ED) visits for the older population. If osteoporosis is present, even falls from standing height can lead to unusual fractures normally associated with high-energy trauma. In this report, we analyze a rare case of an isolated sternal fracture with an unusual mechanism of injury. Our discussion aims to improve care for older adults with fall-related fractures. Case presentation: An 86-year-old female presented in the ED of our hospital with a complaint of chest pain. She recalled a fall at home the previous day and described how her fist was impacted between the floor and her chest. A physical examination revealed local tenderness in the mid-chest. A lateral chest x-ray indicated a sternal fracture, and a chest computed tomography scan ruled out concomitant injuries. There were no acute changes on her electrocardiogram (ECG). Conservative outpatient treatment was started, and referrals were made with a recommendation to initiate fall prevention measures and osteoporosis screening in primary health care. Conclusions: Geriatric patients can present in the ED with a rare sternal fracture even after only a minor chest trauma. Appropriate imaging and an ECG are warranted to exclude life-threatening additional injuries. An in-depth physical examination and an understanding of the exact mechanism of injury are important to avoid missing fractures in unexpected locations. Modern ED physicians could have an important role in the secondary prevention of fall-related fractures for geriatric patients. [ABSTRACT FROM AUTHOR]

Abstract Background To maximize the therapeutic effect for complicated sternal fracture, we should know advantages and disadvantages of each surgical repositioning technique, and the choice of an appropriate procedure is essential. We report two successful cases for which a combination of two existing techniques, modified Robicsek wire fixation and locked titanium plate fixation, was applied to transverse sternal fracture with flail chest. Case presentation One patient experienced a transverse sternal and rib fracture due to a traffic injury. Flail chest due to a highly displaced transverse sternal fracture made withdrawal of the ventilator impossible. Another patient, who developed fulminant myocarditis, experienced a transverse sternal fracture resulting from chest compression during cardiopulmonary resuscitation. Severe paradoxical respiratory movement was a limiting factor for cardiac and respiratory rehabilitation. In both cases, a transverse sternal fracture was difficult to correct non-invasively and indicated surgical repair. The surgical repositioning and fixation greatly contributed to the improvement of the respiratory movement, and the patients were successfully withdrawn ventilator support. Conclusion The combination of modified Robicsek wire fixation and locked titanium plate fixation for a complicated sternal fracture employs the complementary and comparative advantages of each procedure and effective fixation may be achieved.

A 14-year-old boy presented with a displaced sternal body fracture sustained in a fall from a trampoline. Due to overlap of the bone segments, the fracture was operatively reduced and plated with a 12-hole titanium ladder plate. Although sternal fractures are typically managed with observation, when there is refractory pain or overlap of the fracture segments an operative fixation is necessary.

Manubriosternal joint dislocation (MSD) is a rare traumatic injury, usually preceded by a high energy trauma. We report a case of a 40-year-old female who was involved in a motor vehicle accident and presented to a tertiary trauma centre. She suffered from severe chest wall injuries, including significantly displaced manubriosternal dislocation with lung herniation, bilateral rib fractures and hemopneumothoraxes. She underwent a chest wall reconstruction with open reduction and internal fixation with sternal and costal plates with good functional outcome. In this case report we discuss the management of these rare and unstable type I manubriosternal dislocation with associated rib fractures.

Study Design: Retrospective analysis.Objective: This study aimed to identify the prevalence of concomitant thoracic spinal and sternal fractures and factors associated with concomitant fractures.Summary Of Background Data: The sternum has been implicated in stability of the upper thoracic spine, and both bony structures are included in the stable upper thoracic cage. High force trauma to the thorax can cause multiple fractures to different upper thoracic cage components.Methods: This is a retrospective analysis of electronic medical record data of patients treated at a Level 1 Trauma Center who underwent surgery for thoracic spinal fracture between 2008-2020. We recorded presence of concomitant sternal fracture, injury characteristics, hospital course data, and demographic information.Results: 107 patients with thoracic spinal fractures had a sternal fracture prevalence of 18.7%. The average age was 53.2 [15-90]. 72 (67.3%) were male and 35 (32.7%) were female, 92 (85.9%) were White, 10 (9.3%) were African American, 3 (2.8%) were Hispanic, and 2 (1.9%) were Asian. The average age of patients with sternal fractures was 48.7 years, compared to those without sternal fractures, 54.3 years (P = 0.251). Patients with T1-T7 fractures [14 of 48 (29.2%)] had a significantly higher rate of sternal fractures compared to patients with T8-T12 fractures [6 of 59 (10.2%)] (P = 0.012). Patients with additional rib (P < 0.001), scapula (P = 0.01), clavicle fractures (P = 0.01), and those with multiple other thoracic fractures (P = 0.01) had significantly higher rates of sternal fractures compared to patients without these. Patients with concomitant sternal fractures [10 of 20 (50.0%)] had a significantly higher rate of respiratory complication during their hospital course than patients without concomitant sternal fracture [40 of 87 (46.0%)] (P < 0.001). Sex, age, mechanism of injury, fracture morphology, estimated blood loss during surgery, intraoperative complications, post-surgical intubation status, and post-surgical intubation duration were not associated with sternal fractures.Conclusions: The prevalence of concomitant thoracic spinal fracture and sternal fracture in our series is 18.7%. T1-T7 fractures and presence of rib, scapula, and clavicle fractures were significantly associated with the presence of sternal fractures. Presence of concomitant sternal fracture was significantly associated with respiratory complication during hospital course. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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.

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 < 0.001), manubrium fracture (OR = 6.848; P = 0.015), and motor vehicle accident (OR = 0.342; P = 0.015) were significantly associated with sternal fracture with concomitant injury. Conclusion: Manubrium fracture and retrosternal hematoma portend a high risk of concomitant injury and indicate the need for further clinical and radiologic work-up. [ABSTRACT FROM AUTHOR]

Aim: To describe demographic characteristics and surgical treatment carried out on patients with a sternal fracture (SF) in the last 5 years. Materials and Method: Retrospective descriptive study of patients operated on for SF between January 2015 and January 2020. We analyzed age, sex, morbid history, hemodynamics on admission, causal mechanism and characteristics of sternal injury, associated injuries, surgical indication and complications. Results: During the period, 9 patients were admitted to our hospital (7 men) from 21 to 91 years old. All were operated. Most were admitted with stable hemodynamics. The mechanism was always traumatic. The surgical indications were: intractable pain, alteration of ventilatory mechanics, flail chest, deformity and aid in the rehabilitation of spinal cord trauma. Discussion: SF is an infrequent pathology, its surgical resolution reported worldwide being even scarce. Conclusions: We present the first report of a series of cases of SF operated in Chile. Sternal osteosynthesis allows the management of EF with good functional results with a low morbidity rate. The results obtained are comparable to those observed in the international literature. [ABSTRACT FROM AUTHOR]

Study objectiveWidespread 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.MethodsWe 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.ResultsOf 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).ConclusionsMost 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.

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Background: To maximize the therapeutic effect for complicated sternal fracture, we should know advantages and disadvantages of each surgical repositioning technique, and the choice of an appropriate procedure is essential. We report two successful cases for which a combination of two existing techniques, modified Robicsek wire fixation and locked titanium plate fixation, was applied to transverse sternal fracture with flail chest. Case presentation: One patient experienced a transverse sternal and rib fracture due to a traffic injury. Flail chest due to a highly displaced transverse sternal fracture made withdrawal of the ventilator impossible. Another patient, who developed fulminant myocarditis, experienced a transverse sternal fracture resulting from chest compression during cardiopulmonary resuscitation. Severe paradoxical respiratory movement was a limiting factor for cardiac and respiratory rehabilitation. In both cases, a transverse sternal fracture was difficult to correct non-invasively and indicated surgical repair. The surgical repositioning and fixation greatly contributed to the improvement of the respiratory movement, and the patients were successfully withdrawn ventilator support. Conclusion: The combination of modified Robicsek wire fixation and locked titanium plate fixation for a complicated sternal fracture employs the complementary and comparative advantages of each procedure and effective fixation may be achieved. [ABSTRACT FROM AUTHOR]

• 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]

Abstract 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.

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.

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. [ABSTRACT FROM AUTHOR]

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

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Introduction: This case raises awareness of the diagnosis of sternal fracture during labor and obviates the need for lengthy, expense-consuming workup. This report identifies a subset of women who may be at higher risk for this pathology. Methods: Upon diagnosing and treating a patient who spontaneously fractured her sternum during labor, we reviewed previously reported cases and highlight key points of this entity. Results: We report the third case of sternal fracture during labor in a healthy primigravida with female athlete triad. After 12 h of labor, the woman underwent epidural placement. By 16 h, the cervix was fully dilated. During the second push in the chin-to-chest position, a healthy baby was delivered, but the mother experienced acute anterior chest pain. Tenderness persisted for three weeks. Plain radiographs confirmed the presence of the fracture, which healed spontaneously. Conclusion: While chest pain during labor often results from serious causes including pulmonary embolism, myocardial infarction, and spontaneous pneumothorax, hyperflexion sternal fracture can occur, particularly in a woman with female athlete triad.

We sought to investigate the diagnosis, management, and outcomes of pediatric sternal fractures. We used ICD codes to search our trauma registry and Hound Dog software to search the hospital data warehouse for all cases of radiologically confirmed sternal fracture in patients < 21 years from January 1, 1997 to July 1, 2017. We extracted demographics, mechanism of injury, diagnostic modality, associated injuries, and clinical outcomes. We identified 65 children with sternal fractures. 46/65 (71%) were male, with median age 11 years. 34/65 (52%) presented to our emergency department (ED) and the remainder to outpatient clinics. 41/65 (63%) were diagnosed by chest X-ray, 11/65 (17%) by chest CT, 7/65 (11%) by sternal X-ray, and 5/65 (8%) by MRI. Mechanism of injury varied by age. The majority, 50/65 (77%), were isolated injuries and there were no cardiac injuries, aortic injuries or deaths. 18/33 (45%) of those who presented initially to the ED were admitted, and of these 7/18 (39%) had isolated sternal fractures. In this series, most sternal fractures were isolated with low morbidity. Sternal fracture alone should not prompt aggressive workup for intrathoracic injuries and stable patients with isolated sternal fractures can be safely followed without admission. IV. [ABSTRACT FROM AUTHOR]

Purpose: Sternal fractures are rare injuries and mostly treated non-operatively. In selected cases, internal fixation becomes necessary. No standard operative approach has been determined yet among experts. The aim of this study is to describe our treatment algorithm and results after operative stabilisation of sternal fractures with locking compression plates (LCP), mainly focusing on the functional outcome. Methods: A retrospective cohort study was conducted. We included all patients after operative stabilisation of a sternal fracture between 2008 and 2016. Endpoints were the functional outcome using the Activities of Daily Living (ADL) score, pain analysed by the numeric rating scale (NRS), breathing ability, complications and implant removal. Results: Eighteen out of 153 (12%) patients with a sternal fracture underwent operation. Three patients were lost to follow-up. Eleven out of 15 (73%) patients were treated with double straight LCP 3.5 mm implants and 4 (27%) patients with pre-countered LCP 3.5 mm implants. Mean follow-up was 57 months. The median ADL score was 1 (1–4), the median NRS was 0 (0–9), and respiratory complaints scored a median of 1 (1–4). No non-union, hardware failure or implant-related complication occurred. Post-operative complications were pneumonia (20%) and respiratory insufficiency (20%). Implants were removed in 4/15 (27%) patients; three times due to implant-related irritation, once on patient's request. Conclusion: Operative stabilisation of sternal fractures with double LCP 3.5 mm provides excellent long-term functional results and seems to be an appropriate option for internal fixation. The rate of post-operative complications is low; however, 27% had a second operation for implant removal. [ABSTRACT FROM AUTHOR]