Concomitant Sternal Fracture in Flail Chest: An Analysis of 21,741 Polytrauma Patients from the TraumaRegister DGU®

Abstract

Isolated sternal fractures (SFs) rarely show complications, but their influence in a thorax trauma of the seriously injured still remains unclear. A retrospective analysis of the TraumaRegister DGU was performed involving the years 2009 to 2013 (Injury Severity Score [ISS] ≥ 16, primary admission to a trauma center). Cohort formation: Unilateral and bilateral flail chest (FC) injuries with and without a concomitant SF, respectively. In total, 21,741 patients (25% female) met the inclusion criteria, with 3,492 (16.1%) showing SF. Unilateral FC patients were on average 53.6 ± 18.4 years old, and bilateral FC patients were on average 55.2 ± 17.7 years old. The ISS in unilateral FC and bilateral FC amounted to 31.2 ± 13.0 and 43.4 ± 13.1 points, respectively. FC with an SF occurred more frequently as an injury to car occupants and less frequently as an injury to motorcyclists or in injuries due to falls. Patients with an SF additional to an FC had longer hospital and intensive care unit stays and were longer artificially respirated than those patients without an SF. SF indicates possible cardiac and thoracic spine injuries.

Surgical Stabilization of Costoclavicular Injuries - A Combination of Flail Chest Injuries and a Clavicula Fracture

“…Data from the German Trauma Registry DGU ® could proof that almost every second severely injured patient (ISS >=16) suffers from relevant rib fractures (AIS >=2) and every 6 th patient sustained a FC injury which is associated with a high rate of multiorgan failure (MOF) and mortality (4). Furthermore an additional sternal fracture (SF) in FCI accelerates the due of mechanical ventilation and the risc of concomitant cardiac injuries as well as those of the thoracic spine (5).…”

The Operative Management of Flail Chest Injuries with Concomitant Sternal Fracture

“…Moreover an additional sternal fracture (SF) in those injuries occurs in about 10 % in case out of monolateral FCI and 21 % in bilateral FCI (1). As these combinations are associated with even a higher number of complications, such as the duration of mechanical ventilation, an operative fixation of the chest wall fractures could be considered in certain cases to improve the weaning from the ventilator (2,3,4).…”

Efficacy of nickel‑titanium memory alloy in the treatment of multiple rib fracture combined with sternal fracture

“…According to Yang et al (15), mortality rate of the flail chest is approximately 16% which is increased if the flail chest is combined with a sternal fracture (16). Industry stepping into the advanced stage, multiple rib fractures combined with sternal fractures, with a rocketing growth of incidence rate and severe damage to human health, have become the focus of modern medicine (9,17). The advancement of the new internal fixation equipment makes the operation of patients with fractures easier and safer, for example, the nickel-titanium memory alloy, with its good histocompatibility to be deformed and deployed at low temperature and to automatically restore the original shape at body temperature, is of great help for the convenience of the fixation, the shortening of the operation time, the decrease of injuries around the fracture, and the maintenance of effective blood circulation.…”