Associated Injuries in Traumatic Sternal Fractures: A Review of the National Trauma Data Bank

Oyetunji, Tolulope A.; Jackson, Hope T.; Obirieze, Augustine; Moore, Danier; Branche, Marc; Greene, Wendy R.; Cornwell, Edward E.; Siram, Suryanarayana M.

doi:10.1177/000313481307900714

Cited by 56 publications

(47 citation statements)

References 17 publications

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“…They were associated with rib fractures and hemothorax/hemopneumothorax. A most recent study [12] found similar results, with 3.6% of cardiac contusion, 16.9 % of lumbar fractures. In this study, mortality rate was 7.9%.…”

Section: Sternal Fracturessupporting

confidence: 61%

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2015

JACCOA

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Wounds on the thoracic wall Rib fractures: Rib fractures are the most common injuries in trauma centers and secondary care hospitals. They are commonly seen in adults, usually secondary to blunt trauma that can be an insignificant injury or rather can lead to serious complications due to injuries of the internal organs. Rib fractures are clinically manifested by local tenderness, hematomas, inspiratory pain or while coughing. They tend to be complicated with pneumonia, flail thorax, hemothorax, hemopneumothorax, pulmonary contusions, or vascular lesions. It is mandatory to initiate an effective analgesic

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Section: Sternal Fracturessupporting

confidence: 61%

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2015

JACCOA

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“…In trauma patients, additional variables, such as the ISS and the critical need for prehospital intubation, increase the risk of developing pneumonia [ 15 ]. Multiple previous studies have reported that trauma factors, such as pulmonary contusion, rib fracture, sternal fracture, and traumatic brain injury, increased the risk of developing pneumonia [ 4 , 5 , 16 , 17 ]. In the present study, the overall rate of VAP development was approximately 45.5%.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

Park

Kang

Moon

et al. 2017

Korean J Thorac Cardiovasc Surg

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BackgroundVentilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures.MethodsWe retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score.ResultsForty-six patients (45.5%) had at least 1 episode of VAP, 10 (21.7%) of whom died in the ICU. Of the 55 (54.5%) patients who did not have pneumonia, 9 (16.4%) died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029).ConclusionSevere pulmonary contusion (pulmonary lung contusion score 6–12) is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.

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“…Sternal fracture is a common injury often associated with fractures of vertebrae, most commonly thoracic [ 3 , 4 ]. Oyetunji et al [ 5 ] in an analysis of 23,985 trauma bank records in the USA reported 21.6% association with thoracic vertebra fracture and 16.9% with lumbar vertebra fractures. The overall mortality of sternal fractures is 0.7% but the mortality may increase to 10% in the presence of other associated injuries [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Parasternal Block Allows Optimal Pain Relief and Ventilation Improvement After a Sternal Fracture

et al. 2016

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IntroductionSternal fractures are a painful condition which can result in pulmonary morbidity if not treated promptly. The management of isolated fractures has changed from hospital to home-based treatment, provided other major injuries have been excluded. Pain management is the mainstay of treatment. In this case report, we describe how a parasternal block under ultrasound guidance for sternal fracture provided better analgesia thereby improving ventilation.Case reportA 26-year-old man was admitted to the emergency department following a road traffic accident. His initial evaluation revealed a radio-cubital displaced fracture at the elbow level with severe tenderness over the sternum. Chest X-ray on admission did not reveal any abnormality. On preoperative checkup he was found to have altered chest mechanics with severe pain and tenderness over the sternum. Arterial blood gas (ABG) analysis showed respiratory acidosis. Pulmonary electrical impedance tomography showed hypoventilation of anterior portions of both lungs. An ultrasound examination of the sternum showed a fractured sternum with complete disjunction. An ultrasound-guided bilateral parasternal block was performed which resulted in efficient analgesia and thereby improved his ventilation as indicated by the improvement in ABG.ConclusionTimely and proper analgesia can reduce the pulmonary morbidity in sternal fractures. Of the various analgesic techniques, parasternal block under ultrasound guidance is a relatively simple, safe, and target-specific procedure that can provide efficient pain relief.Electronic supplementary materialThe online version of this article (doi:10.1007/s40122-016-0050-5) contains supplementary material, which is available to authorized users.

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Associated Injuries in Traumatic Sternal Fractures: A Review of the National Trauma Data Bank

Cited by 56 publications

References 17 publications

Untitled

Untitled

Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

Ultrasound-Guided Parasternal Block Allows Optimal Pain Relief and Ventilation Improvement After a Sternal Fracture

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