Missed manubriosternal dislocation in patient with thoracolumbar fracture, a case report

Abstract

Background Spine fractures combined with sternal injury are most commonly occur in the thoracic region. Lower cervical and thoracolumbar injuries have also been reported, especially for the patients with manubriosternal dislocation. The type of spine injury is easily recognized in initial presentation, but we may miss the sternal fracture and manubriosternal dislocation. Case presentation A 23-year-old male patient complained with chest, right ankle, and lumbar pain after a fall at ground level, with diagnosis of right distal tibial fracture, sternal fracture, calcaneus fracture, and L2 vertebral fracture. However, neurologically he was completely normal. He underwent the operation for his lower extremity and spine, but we missed his manubriosternal dislocation after discharged. After one month, he came to the clinic with complained of chest pain, the imaging exams showed anterior dislocation of manubriosternal joint. We chose conservative treatment for manubriosternal dislocation. He was followed up at monthly intervals and radiographs along with computerized tomography showed satisfactory in fracture healing of lumber and the sternal fracture. However, the manubriosternal dislocation was malunioned. The patient had appearance deformity of the manubriosternal joint. Conclusion This case supports the concept of the existence and clinical relevance of the thoracic cage theory, the thoracolumbar vertebrae should also be included in the thoracic cage theory.

Current treatment and outcomes of traumatic sternovertebral fractures: a systematic review

“…Six patients (10%) had a wound infection, of whom one patient had a haloframe pin tract infection (pneumonia and wound infection were only reported by Klei [2]). Median hospital length of stay was 17 days (IQR 8-24 days), but was not reported by Labbe [10], Regauer [26], and Jiang [11].…”

“…In literature, the thoracic spine is regarded as the preferential location for sternovertebral fractures [1,4,[7][8][9][10][11][12]. However, concomitant cervical or lumbar spinal fractures with an incidence similar to or higher than thoracic spinal fractures are also reported [1,2,[4][5][6][13][14][15][16][17][18][19][20].…”

“…Treatment methods and outcomes a CONS conservative treatment, OP operative treatment, LOS length of stay, IQR interquartile range Overall treatment failure included technical failure (malpositioned screws and pain due to osteosynthesis materials) Not reported by Labbe et al[10], Regauer et al[26], and Jiang et al[11] f This patient was included in the operative spinal treatment group due to his thoracic fracture, but secondary dislocation of a conservatively treated odontoid fracture occurred…”