Sternal Fracture Should Prompt the Evaluation of the Entire Spine in Trauma Patients

Sternal fracture has traditionally been considered an indicator of a severe mechanism of trauma, which warrants careful evaluation of the patient for accompanying injuries. The purpose of this study is to determine the incidence, distribution and mechanisms of spinal fractures associated with fractures of the sternum. Trauma registry data, medical records and X-rays of all patients admitted to the Trauma Unit at Hillel-Yaffe Medical Center, Hadera, Israel, with a diagnosis of sternal fracture during a 6-year period, between January 1, 1997 and December 31, 2002, were reviewed retrospectively. 147 patients with sternal fracture were eligible for analysis. The combination of spinal fracture in association with sternal fracture was found in 19 patients (13%), ten males (52.7%) and nine females (47.3%). Mean age was 49 years and mean Injury Severity Score (ISS) 18.6. Motor vehicle accidents were the most common cause of these fractures. An unusually high proportion of cervical spine fractures (36.8%) was noted. Three of the 19 patients (15.5%) with sternal and spinal fractures also suffered from cardiac contusion, confirmed by an elevation of the MB fraction of creatine phosphokinase, ECG changes, and regional hypokinetic areas on echocardiography. Recent studies indicate that the incidence of sternal fracture has risen while its association with accompanying serious injuries has lessened. This is most likely due to the increased use of seat belts in motor vehicle accidents. In both theory and practice spinal fracture is an associated injury in cases of sternal fracture, and usually involves the thoracic level. The authors describe an almost equal distribution of the level of spinal injury, with an unusually high proportion of cervical involvement. They also found a high incidence of myocardial contusion among patients with combined sternal and spinal fractures. Therefore, X-ray evaluation of the entire spine in patients suffering from a fractured sternum, and closer cardiac monitoring of patients with both sternal and spinal fractures are recommended.