The oblique fracture of the manubrium sterni caused by a seatbelt—a rare injury? Treatment options based on the experiences gained in a level I trauma centre

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

doi:10.1007/s00264-015-2801-z

Cited by 17 publications

(18 citation statements)

References 17 publications

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“…The more frequent transverse fractures nearby the angulus can be supplied very well by means of longitudinal plate osteosynthesis, while oblique manubrium fractures can be adequately stabilized by transverse plate osteosynthesis (9,10). The latter occur frequently also with rib fractures, as a rule caused by a belt trauma to the car occupant.…”

Section: Introductionmentioning

confidence: 88%

The Operative Management of Flail Chest Injuries with Concomitant Sternal Fracture

Schulz-Drost¹,

Krinner²,

Langenbach³

et al. 2017

chr

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RezumatDate generale: Leziunile de volet costal (FCI) sunt unele dintre cele mai grave leziuni toracice. Mai mult decât atât, o fractură de stern suplimentară (SF) chiar agravează rezultatele, cum ar fi durata ventilaţiei mecanice, prin urmare o fixare chirurgicală a fracturilor poate fi luată în considerare în anumite cazuri pentru a grăbi deconectarea ventilatorului. Această lucrare urmăreşte să sublinieze managementul diferitelor tipuri de SF în FCI. Metode: Toate cazurile tratate chirurgical (2012)(2013)(2014)(2015)(2016) Original ArticleCuvinte cheie: volet costal, fractură de stern, fractură sternală, fractură costală, osteosinteză cu placă blocată, Matrix Rib Abstract Background: Flail Chest Injuries (FCI) are one of the most severe thoracic injuries. Moreover, an additional sternal fracture (SF) even worsens the outcome, such as the duration of mechanical ventilation, therefore an surgical fixation of the fractures could be considered in certain cases to improve the weaning from the ventilator. This paper aims to emphasize on the management of different types of SF in FCI. Methods: All surgically treated cases (2012)(2013)(2014)(2015)(2016) that showed the combination of FCI and SF have been evaluated for their clinical details, the morphology of the fractures and the technical aspects of the surgical procedure in a retrospective investigation.Results: All of the SF (n=15) had been fixed by locked plate osteosynthesis through a median approach in a supine position. Three main regions of the sternum showed the need for different fixation strategies: the upper manubrium, central and lower corpus sterni. Concomitant rib fractures were addressed either through the same approach or through additional limited incisions. Conclusions: Combinations of SF and FCI are high risc injuries with high demand on surgical skills. They can be properly fixed with a locking plate osteosynthesis through a combination of limited incisions employing different types of plates depending on the type of SF.

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Section: Introductionmentioning

confidence: 88%

The Operative Management of Flail Chest Injuries with Concomitant Sternal Fracture

Schulz-Drost¹,

Krinner²,

Langenbach³

et al. 2017

chr

Self Cite

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“…The conservative treatment of stable and undisplaced fractures is the method of choice in fractures of the chest wall (6,8,15). Dislocated and unstable fractures, on the other hand, may be a useful indication for surgical stabilization, which was then performed by means of a locked plate osteosynthesis based on the best known results of this technique without any complications like wire-dislocation (21,22).…”

Section: Treatment Optionsmentioning

confidence: 99%

“…The sternum has different fracture types, depending on the injury mechanism since direct blunt trauma, indirect impact, and forced traction of muscles can cause sternal fractures (1). While fractures of the corpus sterni are mainly caused by direct forces, i.e., the impact to the steering wheel, manubrium fractures from other fracture mechanisms appear to be relevant (3,7,8). Gurlt reported in 1864 that all patients with oblique manubrium fractures had died (9).…”

Section: Introductionmentioning

confidence: 99%

“…A systematic review of trauma scans in a Level 1 Trauma Center in Germany proved that oblique fractures of the manubrium have a higher incidence than expected, often lead to mediastinal hematoma, and are usually accompanied by severe injuries due to road traffic accidents. Oblique manubrium fractures are mainly caused by a combination of seat belt impact and a retroflexion of the shoulder (8).…”

Section: Introductionmentioning

confidence: 99%

“…Sagittal dislocations can be avoided by applying a longitudinal plate. Oblique fractures of the manubrium tend to dislocate laterally and can be stabilized by transversal plates (8,17). Indications for plate osteosynthesis have been summarized by Harston: displaced and overlapped fractures that cannot be corrected by closed reduction, sternal instability, chronic nonunion and severe pain making with restriction of respiratory movements (15).…”

Section: Introductionmentioning

confidence: 99%

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Fractures of the manubrium sterni: treatment options and a possible classification of different types of fractures

et al. 2018

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Background: Sternum fractures are mostly located on the sternal corpus, seldom on the manubrium.Fractures of the sternal manubrium are, however, more frequently associated with severe concomitant injuries of thoracic organs, and therefore deserve special attention. In addition, in its function as a capstone in between the anterior chest wall and the shoulder girdle, it is exposed to a multiplicity of forces. Therefore the questions arise what types of fractures are observed in today's clinical practice, how to classify them and which treatment options are available. This study reports on different types of fractures which involve the manubrium sterni. Methods: Between January 2012 and October 2014, data was collected from all severely injured patients (ISS ≥16), which received a CT scan of the thorax in our Level-I-Trauma Center and retrospectively analyzed concerning sternal fractures. Fracture type, collateral injuries, age, and information about the circumstances of the accident were noted. Results: Of 890 evaluable patients, 154 (17.3%) had a fracture of the sternum and 23 (2.6%) of the manubrium. Fractures of the manubrium appeared in following types: A-type-transverse fracture (n=11) in 1st intercostal space by direct blunt trauma or flexion of the torso with sagittal instability; B-type-oblique fracture (n=9) by seat belt injury with rotatory instability; C-type-combined, more fragmentary fracture (n=3) by direct blunt trauma with simultaneous flexion of the torso and multi directional instability. Fractures only little dislocation were treated conservatively, and unstable fractures were surgically stabilized (n=10). Conclusions: In summary, three main types of fractures could be found. A-type fractures were stabilized with a longitudinal plate osteosynthesis and B-type fractures with transverse positioned plates. To treat complex C-type fractures, plates with a T-or H-form could be a good solution.Level of evidence: Level III retrospective prognostic cohort study

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Bony and Thoracic Chest Wall Injuries

Wirth

Jansen

2016

Emergency Radiology of the Chest and Cardiovascular System

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The oblique fracture of the manubrium sterni caused by a seatbelt—a rare injury? Treatment options based on the experiences gained in a level I trauma centre

Cited by 17 publications

References 17 publications

The Operative Management of Flail Chest Injuries with Concomitant Sternal Fracture

The Operative Management of Flail Chest Injuries with Concomitant Sternal Fracture

Fractures of the manubrium sterni: treatment options and a possible classification of different types of fractures

Bony and Thoracic Chest Wall Injuries

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