Travmatik sternum fraktürleri: Tanı ve tedavi

Amaç: Sternum fraktürleri göğüs travması nedeniyle acil servise başvuran hastalarda görülen patolojilerin küçük bir yüzdesini oluşturmaktadır. Ancak, kardiyak yaralanmanın habercisi olabilmeleri nedeniyle tanı ve izlemleri önem kazanmaktadır. Bu çalışmanın amacı sternum fraktürlü hastaların tanı, izlem ve tedavisindeki yaklaşımların tartışılmasıdır. Gereç ve Yöntem: Ocak 1998 - Aralık 2008 arasında göğüs travması nedeniyle acil servisimize başvuran ve sternum fraktürü saptanarak kliniğimize yatırılan 22 hasta; fraktür lokalizasyonu, şekli, izlem, tedavi yöntemleri ve komplikasyonlar açısından retrospektif olarak değerlendirildi. Bulgular: Sternum fraktürü nedeninin 13 (%59.1) hastada araç içi trafik kazası olduğu, bu hastalardan 11'inin (%84.6) emniyet kemeri taktığı belirlendi. Radyolojik incelemede, hastaların 19'unda (%86.4) korpusta, 3'ünde (%13.6) manubriumda kırık izlendi. Fraktür olguların 12'sinde (%54.5) deplase, 10'unda (%45.5) non-deplase idi. Hastaların 14'ünde (%63.6) kardiyak enzim yüksekliği, 5'inde (%22.7) EKG değişiklikleri, 4'ünde (%18.2) ekokardiyografide patolojik bulgular saptandı. Olguların 18'ine (%81.8) izlem, 3'üne (%13.6) ek patoloji nedeniyle tüp torakostomi, 1'ine ise (%4.6) cerrahi fiksasyon uygulandı. Mortalite izlenmezken, hastanede ortalama kalış süresi 5.7 gün olarak bulundu. Sonuç: Göğüs travması nedeniyle acil servise başvuran hastaların tümüne sternum fraktürünün değerlendirilmesi amacıyla lateral göğüs grafisi çekilmelidir. Elektrokardiyografi veya kardiyak enzimlerde anormallik bulunması halinde hastalar ekokardiyografi ile değerlendirilmelidir. Tedavide genellikle konservatif yaklaşım yeterli olmakla birlikte; yelken göğüs deformitesine neden olup solunumu bozan non-deplase fraktürlerde cerrahi fiksasyon gecikmeden uygulanmalıdır.

Traumatic sternal fractures: Diagnosis and management

Aim: Despite the fact that the number of patients with sternum fractures is only a small percent of all thoracic trauma patients treated in emergency rooms, diagnosis and management is important due to the possibilty of associated cardiac injuries. The aim of this study is to discuss the diagnosis, management and therapy options of patients with sternal fractures after thoracic trauma. Material and Methods: Twenty-two patients were diagnosed with sternal fractures after thoracic trauma in the emergency room of our hospital between January 1998 and December 2008 and were treated at our clinic. Location and type of fractures, treatment methods and complications were evaluated retrospectively. Results: The reason for the trauma was a vehicular traffic accident in 13 patients (59.1%) and eleven (84.6%) of these patients wore a seat belt. Sternal fractures were localized at corpus in 19 patients (86.4%) and at manubrium in 3 patients (13.6%). Cardiac enzyme levels increased in 14 patients (63.6%) and pathologic findings in electrocardiography and echocardiography were observed in 5 (22.7%) and 4 (18.2%) patients, respectively. Eighteen patients (81.8%) were followed without any surgical intervention, tube thoracostomy was performed in 3 patients (13.6%). One patient (4.6%) was managed by surgical fixation. The mean hospital stay was 5.7 days. Conclusion: Lateral chest radiograms should be performed on all patients after thoracic trauma to diagnose any sternum fracture. Patients with pathological findings should be evaluated with echocardiography. Management of patients with sternal fractures is usually conservative, but patients with deplased sternal fractures causing flail chest should be treated with early surgical fixation.

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