Fahri OĞUZKAYA, Yiğit AKÇALI, Leyla HASDIRAZ, Mehmet BİLGİN

Isolated sternal fractures: A hallmark of violent injury

Amaç: İzole sternal kırıklar diğer kemik kırıkları ile kıyaslandığında nadir görülür. Bu kırıkların en sık nedeni trafik kazalarıdır. Bu çalışmada, cerrahi veya cerrahi dışı girişimlerle tedavi edilen izole sternum kırıkları değerlendirildi. Çalışma planı: Çalışmada göğüs travması sonucu oluşan izole sternum kırığı nedeniyle tedavi edilen 47 hasta (38 erkek, 9 kadın; ort. yaş 38; dağılım 27-70) kırığın yeri, şekli, tipi, tedavi yöntemleri ve komplikasyonlar açısından incelendi. Kırık tanısı, arka-ön ve yan göğüs radyografileri ile kondu.Bulgular: İzole sternum kırıklarının nedeni 41 hastada (%87.2) trafik kazaları idi ve bu hastaların çoğunluğu (n=36) emniyet kemeri kullanıyordu. Yirmi dokuz hastada (%61.7) kırık yeri orta gladiolustaydı. Beş hastada ayrışmamış sternomanubrial kırık vardı. Dört hastanın kırığı 1/3 alt sternumdaydı. Yedi hastada presternal hematom saptandı. Yaralanma ile tedavi arasında geçen ortalama süre 6.3 saat idi. Dört hastada (%8.5) pnömotoraks saptandı. Dokuz hastanın (19.2%) elektrokardiyografisinde ST-T değişikliği görüldü. Sekiz hasta, omurga hiperekstansiyona getirilerek kapalı manipülasyonla tedavi edilirken, sternal kırığı parçalı ve hareketli olan 13 hastaya çelik tel ile cerrahi redüksion yapıldı. Hastalarda komplikasyon veya mortalite görülmedi. Ortalama hastanede kalış süresi 8.3 gün (dağılım 4-13 gün) bulundu.Sonuç: İzole sternum kırıklarının tedavisi genellikle konservatiftir; ancak, bazı hastalarda cerrahi tedavi gerekebilir. Bu hastalarda kalp ve büyük damar yaralanma olasılıklarına karşı kardiyak enzimlerin ve EKG değişikliklerinin izlenmesi gerekir.

İzole sternum kırıkları: Şiddetli bir yaralanmanın işareti

Background: Sternal fractures are rare injuries compared to fractures of other bones, and their main cause is traffic accidents. We evaluated isolated sternal fractures that were treated by surgical or nonsurgical interventions. Methods: Forty-seven patients (38 men, 9 women; mean age 38 years; range 27 to 70 years) were treated for isolated sternal fractures. The patients were evaluated in terms of location, shape, and type of fractures, treatment methods, and complications. Posteroanterior and left lateral chest radiograms were used for the diagnosis.Results: Forty-one patients (87.2%) were injured by a traffic accident and the majority of these patients (n=36) wore a seat belt. Sternal fractures were localized in the mid-gladiolus in 29 patients (61.7%). Five patients had an unseparated sternomanubrial fracture, and four patients had sternal fracture in the lower one-third of the sternum. Seven patients had presternal hematoma. The average time from injury to treatment was 6.3 hours. Four patients (8.5%) had pneumothorax. Electrocardiography showed ST-T changes in nine patients (19.2%). Eight patients were managed by closed manipulation with hyperextension of the spine, and 13 patients with separated and unstable sternal fractures were managed by surgical fixation with steel wiring. No complications or mortality occurred. The mean hospital stay was 8.3 days (range 4 to 13 days).Conclusion: The management of patients with isolated sternal fractures is usually conservative. However, some patients may require surgery. In order to prevent possible cardiac and cardiovascular complications, electrocardiographic and cardiac enzymatic changes should be monitored.

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1) Battistella FD, Benfield JR. Blunt and penetrating injuries of the chest wall, pleura, and lungs. In: Shields TW, editor. General thoracic surgery. Vol. 1, 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2000. p. 815-32.
2) Campbell BJ. Safety belt injury reduction related to crash severity and front seated position. J Trauma 1987;27:733-9.
3) Gallo DR, Lett ED, Conner WC. Surgical repair of a chronic traumatic sternal fracture. Ann Thorac Surg 2006; 81:726-8.
4) Budd JS. Effect of seat belt legislation on the incidence of sternal fractures seen in the accident department. Br Med J 1985;291:785.
5) Hensinger RN, Berkoff HA. Traumatic non-union of the sternum (report of a case). J Trauma 1975;15:159-62.
6) Rice D, Bikkasani N, Espada R, Mattox K, Wall M. Seat beltrelated chondrosternal disruption with lung herniation. Ann Thorac Surg 2002;73:1950 1.
7) Richardson JD, Grover FL, Trinkle JK. Early operative management of isolated sternal fractures. J Trauma 1975; 15:156-8.
8) Gibson LD, Carter R, Hinshaw DB. Surgical significance of sternal fracture. Surg Gynecol Obstet 1962;114:443-8.
9) Metaxas EK, Condilis N, Tzatzadakis N, Dervisoglou A, Gerazounis MI, Athanasas G. Sternal fracture with or without associated injuries. Assessment of the difference in the diagnosis, management and complications. Eighteen years of experience. Ann Ital Chir 2006;77:379-83.