Are sternum fractures really indicative of severe trauma?
Are sternum fractures really indicative of severe trauma?
Aim: To investigate the need for echocardiography in cases of sternum fracture through a retrospective analysis of the data ofpatients treated for post-traumatic sternal fracture. Although sternum fractures are known to be an indicator of the severity oftrauma and cardiac injury, it should be evaluated whether this is always the case or whether sternum fractures could be consideredbenign traumas.Material and Methods: Data of 63 patients admitted to the emergency department after trauma and treated for sternum fracturebetween August 2014 and October 2016 were retrospectively analyzed.Results: Of the patients, 29 (46%) were female and 34 (54%) male. The mean age was 54.4±21.9 (14-89) years. Chest pain was themost common complaint among these patients admitted to the emergency department. All patients had blunt thoracic trauma. Themost common injuries concomitant of sternum fractures were rib fractures. While electrocardiography and echocardiography wereperformed in all patients on admission to the emergency department, pericardial effusion was detected in only 1 patient by Echo.There was no significant relationship between the type of trauma exposure and the region of fracture in the sternum. All patientswere treated conservatively with close follow-up for sternal fracture.Conclusion: We suggest that routine echocardiography may be unnecessary if there are no anomalies in electrocardiographyfindings, no cardiac marker positivity is detected and no displaced fractures are present in the computed tomography of the thoraxin patients admitted to the emergency department after traum.
___
- 1. Potaris K, Gakidis J, Mihos P, et al. Management of sternal fractures: 239 cases. Asian Cardiovasc Thorac Ann 2002;10:145-49.
- 2. Chiu WC, D’Amelio LF, Hammond JS. Sternal fractures in blunt chest trauma: A practical algorithm for management. Am J Emerg Med 1997;15:252-5.
- 3. Harston A, Roberts C.Fixation of sternal fractures: A systematic review. J Trauma Acute Care Surg 2011;71:1875– 9.
- 4. Fowler AW. Flexion-compression injury of the sternum. J Bone Joint Surg Am 1957;39:487-97.
- 5. Athanassiadi K, Gerazounis M, Moustardas M, et al. Sternal fractures: Retrospective analysis of 100 cases. World J Surg 2002;26:1243-6.
- 6. Johnson I, Branfoot T. Sternal fracture-A modern review. Arch Emerg Med 1993;10:24-8.
- 7. Tanahashi M, Niwa H. Chest Wall Injury. Kyobu Geka 2015;68:689-94.
- 8. Wiener Y, Achildiev B, Karni T, Halevi A. Echocardiogram in sternal fracture. Am J Emerg Med 2001;19:403-5.
- 9. Gibson LD, Carter R, Hinshaw DB. Surgical significance of sternal fracture. Surg Gynecol Obstet 1962;114:443–8.
- 10. Brookes JG, Dunn RJ, Rogers IR. Sternal fractures: A retrospective analysis of 272 cases. J Trauma 1993;35:46- 54.
- 11. Perez MR, Rodriguez RM, Baumann BM, Langdorf MI, Anglin D, Bradley RN et al. Sternal fracture in the age of pan- scan. Injury 2015;46:1324–7.
- 12. Özkaya M, Bedel C. Can neutrophil to lymphocyte ratio and platelet to lymphocyte ratio predict the severity of sternum fractures? Curr Thorac Surg 2018;3:116-22.
- 13. Queitsch C, Kienast B, Voigt C, et al. Treatment of posttraumatic sternal non-union with a locked sternum osteosynthesisplate(TiFix). Injury 2011;42:44-6.
- 14. Karmy-Jones R, Jurkovich GJ. Blunt chest trauma. Curr Probl Surg 2004;41:223-380.
- 15. Knobloch K, Wagner S, Haasper C, et al. Sternal fractures occur most often in old cars to seat-belted drivers without any airbag often with concomitant spinal injuries: Clinical findings and technical collision variables among 42,055 crash victims. Ann Thorac Surg 2006;82:444-50.
- 16. Knobloch K, Wagner S, Haasper C, et al. Sternal fractures are frequent among polytraumatised patients following high deceleration velocities in a severe vehicle crash. Injury 2008;39:36-43.
- 17. Velissaris T, Tang AT, Patel A, et al. Traumatic sternal fracture: Outcome following admission to a Thoracic Surgical Unit. Injury 2003;34:924–7.