Injuries significantly associated with thoracic spine fractures: A case–control study

Singh, Ranjit; Taylor, David; D’Souza, Donna; Gorelik, Alexandra; Page, Patrick; Phal, Pramit M.

doi:10.1111/j.1742-6723.2009.01209.x

Cited by 12 publications

(6 citation statements)

References 19 publications

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“…While the cervical vertebrae may be mobilised effectively in an awake supine patient, axial loading of thoracolumbar vertebrae through mobilisation is the most effective clinical manoeuvre to detect any pain from a stable fracture. Second, the presence of a cervical spine fracture has previously been shown to be associated with another spinal fracture,21 and this was confirmed in this study, necessitating imaging of the rest of the spine. The presence of any neurological deficit without pain is a further obvious variable, which necessitates imaging of the thoracolumbar vertebrae.…”

Section: Discussionsupporting

confidence: 77%

Can initial clinical assessment exclude thoracolumbar vertebral injury?

et al. 2012

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IntroductionThe aim of this study was to test the hypothesis that all blunt trauma patients, presenting with a Glasgow coma scale (GCS) score of 15, without intoxication or neurological deficit, and no pain or tenderness on log-roll can have any thoracolumbar fracture excluded without imaging.Materials and MethodsAll patients diagnosed with a thoracolumbar fracture presenting to the emergency department of a major trauma centre and having an initial GCS score of 15 were included in the study. Variables collected included type of fracture, mechanism of injury, the presence of pain or tenderness on log-roll, ethanol levels and prehospital opioid analgesia.ResultsThere were 536 patients with thoracolumbar fractures, of which 508 (94.8%) patients had either pain, tenderness or had received prehospital opioid analgesia. A small subgroup of 28 (5.2%) patients who received no prehospital opioid analgesia, did not complain of pain and had no tenderness to the thoracolumbar spine elicited on log-roll. This subgroup was significantly older (p=0.033) and a high proportion of patients (64.3%) had a concurrent fracture of the cervical spine. Within this subgroup, a clinically significant unstable thoracic fracture was present in three patients, with all three patients exhibiting symptoms and signs of neurological injury or having a concurrent cervical vertebral fracture.ConclusionsIn this population of blunt trauma patients with a GCS score of 15, not under the influence of alcohol or prehospital morphine administration, the absence of pain or tenderness on log-roll can exclude a clinically significant lumbar vertebral fracture, but does not exclude a thoracic fracture.

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Section: Discussionsupporting

confidence: 77%

Can initial clinical assessment exclude thoracolumbar vertebral injury?

et al. 2012

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“…Associated injuries have been reported in around 60% of sternal fractures with a mortality rate of 25%–45%. [1519] The variation in the outcome rates across studies could be attributed to the patient age, time for diagnosis, the use of early CT scan imaging, type and severity of associated injuries, and the aggressive monitoring and management plan. [1420] In data extracted from the NTDB, Oyetunj et al .…”

Section: Discussionmentioning

confidence: 99%

Traumatic sternal injury in patients with rib fracture: A single-center experience

Al-Thani

Jabbour

El‐Menyar

et al. 2019

Int J Crit Illn Inj Sci

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Purpose: We aimed to assess the pattern and impact of sternal injury with rib fracture in a Level 1 trauma center. Patients and Methods: We conducted a retrospective review of trauma registry data to identify patients who presented with sternal fracture between 2010 and 2017. Data were analyzed and compared in patients with and without rib fracture. Results: We identified 212 patients with traumatic sternal injury, of them 119 (56%) had associated rib fractures. In comparison to those who had no rib fracture, patients with rib fractures were older (40.1 ± 13.6 vs. 37.8 ± 14.5), were frequently involved in traffic accidents (75% vs. 71%), had higher chest abbreviated injury scale (AIS 2.8 ± 0.6 vs. 2.2 ± 0.5) and Injury Severity Score ( ISS 17.5 ± 8.6 vs. 13.3 ± 9.6), were more likely to be intubated (33% vs. 19%), required chest tube insertion (13.4% vs. 4.3%), and received blood transfusion (29% vs. 17%). Rates of spine fracture, head injury, and solid organ injury were comparable in the two groups. Manubrium, clavicular and scapular fractures, lung contusion, hemothorax, and pneumothorax were significantly more evident in those who had rib fractures. Hospital length of stay was prolonged in patients with rib fractures ( P = 0.008). The overall mortality was higher but not statistically significant in patients with rib fractures (5.0% vs. 3.2%). Conclusions: Sternal fractures are rare, and detection of associated injuries requires a high index of suspicion. Combined sternal and rib fractures are more evident in relatively older patients after chest trauma. This combination has certain clinical implications that necessitate further prospective studies.

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“…Some authors have reported mortality rates in patients with sternal fractures ranging from 24% up to as much as 45% [5, 6]. This high mortality rate is due to associated thoracic, pulmonary, cardiac, and spinal injuries [7–11]. Other studies, however, have shown that only one-third of all patients with sternal fractures in fact also suffered from concomitant injuries [12].…”

Section: Introductionmentioning

confidence: 99%

Location of Sternal Fractures as a Possible Marker for Associated Injuries

Scheyerer

Zimmermann

Bouaicha

et al. 2013

Emergency Medicine International

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Introduction. Sternal fractures often occur together with serious and life-threatening additional injuries. This retrospective study was designed to assess concomitant injuries and develop a correlation between fracture location and the severity of injury. Methods. All patients (n = 58) diagnosed with a fracture of the sternum by means of a CT scan were analysed with respect to accident circumstances, fracture morphology and topography, associated injuries, and outcome. Results. Isolated sternal fractures occurred in 9%. In all other admissions, concomitant injuries were diagnosed: mainly rip fractures (64%), injury to the head (48%), the thoracic spine (38%), lumbar spine (27%), and cervical spine (22%). Predominant fracture location was the manubrium sterni. In these locations, the observed mean ISS was the highest. They were strongly associated with thoracic spine and other chest injuries. Furthermore, the incidence of head injuries was significantly higher. ICU admission was significantly higher in patients with manubrium sterni fractures. Conclusion. Sternal fractures are frequently associated with other injuries. It appears that the fracture location can provide important information regarding concomitant injuries. In particular, in fractures of manubrium sterni, the need for further detailed clinical and radiologic workup is necessary to detect the frequently associated injuries and reduce the increased mortality.

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Injuries significantly associated with thoracic spine fractures: A case–control study

Abstract: Cervical and lumbar spine injuries and rib fractures are significantly associated with T-spine fracture. The presence of these injuries should raise suspicion of concomitant T-spine injury.

Cited by 12 publications

References 19 publications

Can initial clinical assessment exclude thoracolumbar vertebral injury?

Can initial clinical assessment exclude thoracolumbar vertebral injury?

Traumatic sternal injury in patients with rib fracture: A single-center experience

Location of Sternal Fractures as a Possible Marker for Associated Injuries

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