Do low profile implants provide reliable stability in fixing the sternal fractures as a “fourth vertebral column” in sternovertebral injuries?

Krinner, Sebastian; Grupp, Sina; Oppel, Pascal; Langenbach, Andreas; Hennig, F. F.; Schulz-Drost, Stefan

doi:10.21037/jtd.2017.03.37

Cited by 25 publications

(37 citation statements)

References 33 publications

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“…The incidence of sternal injury has increased since the introduction of seatbelt legislation [ 3 , 9 , 10 ]. Additionally, sternal injuries are frequently caused by falls from height or indirect trauma due to spinal flexion-compression injury [ 1 , 2 , 5 , 6 , 11 ]. Traumatic sternal fractures are mostly transverse sternal body fractures, while manubrial and xiphoid fractures occur less frequently [ 3 , 8 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Current treatment and outcomes of traumatic sternal fractures—a systematic review

Klei

Jong

Öner

et al. 2018

International Orthopaedics (SICOT)

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Purpose Traumatic sternal fractures are rare injuries. The most common mechanism of injury is direct blunt trauma to the anterior chest wall. Most (> 95%) sternal fractures are treated conservatively. Surgical fixation is indicated in case of fracture instability, displacement or non-union. However, limited research has been performed on treatment outcomes. This study aimed to provide an overview of the current treatment practices and outcomes of traumatic sternal fractures and dislocations. Methods A systematic review of literature published from 1990 to June 2017 was conducted. Original studies on traumatic sternal fractures, reporting sternal healing or sternal stability were included. Studies on non-traumatic sternal fractures or not reporting sternal healing outcomes, as well as case reports (n = 1), were excluded. Results Sixteen studies were included in this review, which reported treatment outcomes for 191 patients. Most included studies were case series of poor quality. All patients showed sternal healing and 98% reported pain relief. Treatment complications occurred in 2% of patients. Conclusions Treatment of traumatic sternal fractures and dislocations is an underexposed topic. Although all patients in this review displayed sternal healing, results should be interpreted with caution since most included studies were of poor quality.

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Section: Introductionmentioning

confidence: 99%

“…Traumatic sternal fractures are mostly transverse sternal body fractures, while manubrial and xiphoid fractures occur less frequently [ 3 , 8 , 10 ]. Two types of sternal dislocations are distinguished: the sternal body is dislocated either posteriorly (type 1) or anteriorly (type 2) to the manubrium [ 2 , 5 , 7 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Current treatment and outcomes of traumatic sternal fractures—a systematic review

Klei

Jong

Öner

et al. 2018

International Orthopaedics (SICOT)

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“…Corresponding to previous studies, the predominant trauma mechanism was a traffic accident, followed by falls from height. 1,[5][6][7][8][9]26 Mean ISS was 24 and many patients sustained associated thoracic and other injuries, demonstrating that sternovertebral fractures occur primarily in polytrauma patients. Median GCS was relatively high and only 10% of patients suffered from severe brain injury, possibly because most patients with severe brain injury died during hospital admission and were not included in analysis.…”

Section: Discussionmentioning

confidence: 99%

“…1,[5][6][7][8][9]16 Other frequent injury mechanisms are direct-impact traumas or hyperflexion injuries due to falls from height or the falling of heavy objects on the head or chest. 1,6,8,9 In the 4-column spine model proposed by Berg et al 18 in 1993, the sternum and ribs form an essential fourth column of spinal support, in addition to the well-known anterior, middle, and posterior spinal columns. 19 Several studies have since substantiated the biomechanical significance of the sternumrib complex.…”

Section: Introductionmentioning

confidence: 99%

“…Some authors have suggested that surgical fixation of both sternum and spine provides a biomechanical advantage and improved fracture healing. 6 Others have postulated that surgical indications depend on the spinal fracture level, 1 or that spinal fixation alone is sufficient to establish both sternal and vertebral fracture healing. 21 The present retrospective cohort study was performed to assess whether surgical fixation of the sternum is indicated in patients with traumatic sternovertebral fractures in order to achieve uncomplicated healing of both sternal and spinal fractures.…”

Section: Introductionmentioning

confidence: 99%

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No Need for Sternal Fixation in Traumatic Sternovertebral Fractures: Outcomes of a 10-Year Retrospective Cohort Study

Klei

Öner

Leenen

et al. 2020

Global Spine Journal

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Study Design: Retrospective cohort study. Objectives: Combined sternal and spinal fractures are rare traumatic injuries and present a high risk of spinal and thoracic wall instability. Limited research has addressed the treatment of sternovertebral injuries and biomechanical need for sternal fixation to achieve spinal healing. Methods: A 10-year retrospective cohort study was conducted, including patients with sternovertebral fractures admitted to our level-1 trauma centre between 2007 and 2016. Patients who died during hospital admission, military patients, patients with isolated upper cervical spine or lower lumbar spine fractures, and patients lost to follow-up were excluded. Results: In 10 years, 73 patients with sternovertebral fractures were included. Mean injury severity score was 24 (range 4-57). Most sternal fractures were located in the sternal body and manubrium. Spinal fractures were type A (52%), B (40%), or C (8%), and were located in the subaxial cervical (21%), upper thoracic (16%), thoracic (21%), thoracolumbar (47%) area; 7 patients had spinal fractures at multiple levels. Fourteen patients (19%) had a neurological deficit. A total of 42 patients received conservative and 31 patients received operative spinal treatment. Two patients (3%) underwent primary sternal fixation. Sternal failure rate was 1% and biomechanical spinal failure rate was 8%, there was no difference in treatment failure between surgical and conservative spinal treatment. Associated thoracic injuries did not influence sternal or spinal treatment outcomes. Conclusions: These findings indicate that conservative sternal treatment in presence of spinal fractures is safe and effective. The low spinal treatment failure rates imply that sternal fixation is not necessary to achieve spinal stability.

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脊椎骨折と胸骨骨折を合併した症例（sternovertebral fracture）の治療成績(Outcomes of patients with vertebral and sternum fractures (sternovertebral fractures))

泰明

多栄子

比呂人

et al. 2022

Nihon Kyukyu Igakukai Zasshi: Japanese Journal of Japanese Asso

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Sternovertebral fractures, which are simultaneous fractures of the spine and sternum, usually result to body trunk instability. This study aimed at investigating the characteristics, treatment strategies, and outcomes of sternovertebral fractures. Methods: We included 27 cases of sternovertebral fractures diagnosed between 2008 and 2020. The variables investigated were the fracture sites, treatment methods, type of bone union, and complaints. Results: Sternal fractures concerned the sternal body (22 cases), manubrium (3 cases), and both segments (2 cases). Nine patients had displaced sternal fractures. The spine fractures involved the cervical (2 cases), thoracic (17 cases), and lumbar (4 cases) segments, and there were four cases of multiple-level spine fractures. Types I, II, and III column injuries (Denis classification) were identified in 4, 13, and 10 cases, respectively. Complications included multiple rib fractures [12 cases (44%)], hemopneumothorax [7 cases (26%)], and lung contusion [6 cases (22%)]. There were no cases of cardiac or aortic injuries. The sternal fractures were treated conservatively in almost all the cases [26/27 cases (96%)]. Spinal fractures were treated surgically in 17 cases (63%). A satisfactory bone union was obtained in all the cases of sternal and spinal fractures, and complaints were noted in 2/27 (7%) sternal fractures and 14/27 (52%) spinal fractures. Conclusion:The most frequent clinical form of sternovertebral fractures was combined sternal body/thoracic spine fracture. In sternovertebral fractures, sternal fractures are mostly treated by conservative means.

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Do low profile implants provide reliable stability in fixing the sternal fractures as a “fourth vertebral column” in sternovertebral injuries?

Cited by 25 publications

References 33 publications

Current treatment and outcomes of traumatic sternal fractures—a systematic review

Current treatment and outcomes of traumatic sternal fractures—a systematic review

No Need for Sternal Fixation in Traumatic Sternovertebral Fractures: Outcomes of a 10-Year Retrospective Cohort Study

脊椎骨折と胸骨骨折を合併した症例（sternovertebral fracture）の治療成績(Outcomes of patients with vertebral and sternum fractures (sternovertebral fractures))

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