Sternal and vertebral fractures, a well-known association, usually overlooked: review of six clinical cases

Abstract

OBJECTIVE: the association of sternal and vertebral fractures has previously been described in the literature. These lesions are frequently overlooked at the initial evaluation. The purpose of this study was to review and discuss the diagnostic methods used to diagnose these lesions and to highlight the importance of early recognition of these fractures. METHODS: we performed a retrospective analysis of six patients who suffered sternal and concomitant vertebral fractures. Clinical charts and imaging studies were reviewed. RESULTS: all patients were diagnosed with sternal fractures at the initial evaluation, but only two were diagnosed with vertebral fractures. CONCLUSION: failure to recognize these fractures at initial evaluation may be associated with the fact that the upper thoracic region is difficult to explore. In the presence of sternal fractures, a vertebral fracture must be ruled out even though major injuries are not present. A computer tomography (CT) scan and magnetic resonance imaging (MRI) should be obtained despite negative X-rays if clinical suspicion is present.

Upper Thoracic Spine Fracture Associated With Fracture of the Sternum

“…Currently, 3D reconstruction has surpassed the X-ray study. [3][4][5][6][7][8][9][10][11][12] Watkins et al 1 (2005), in a study of cadavers (10 trunks with intact rib cages), performed a multidirectional flexibility test. Their goal was to quantify the degree of stability that the rib cage (ribs and sternum) provides to the upper thoracic spine.…”

“…(Figure 3) This results in severe instability that can lead to neurological damage, chronic pain, or deformity and kyphosis. 7,9 Fractures of the upper thoracic spine are for the most part mechanically stable, given the rigidity provided by the 4th spine described by Berg 2 and they usually are treated orthopedically. When they are associated with an injury to the rib-sternum complex, the spine is destabilized to the extent that internal fixation (reduction?)…”