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

Abstract

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.

Analysis of Missed Skeletal Injuries Detected Using Whole-Body Bone Scan Applied to Trauma Patients: A Case–Control Study

“…In previous studies, rib fractures were identified in up to 56% of cases of multiple trauma [8,[13][14][15], which is in accordance with our results. The delayed diagnosis of a rib fracture may lead to persistent pain, loss of functional lung capacity, pulmonary complications, and prolonged hospitalization [8,14].…”

Sternal fractures and thoracic injury: an analysis of 288 sternal fractures attending a major trauma centre

“…The mortality of SFs admitted was low at 8%, 30 days post injury. Again, this remains in line with other evidence to suggest that although injury severity can be high, mortality remains low [ 14 , 16 , 17 ]. Assessments performed by Simsek et al highlighted a mortality rate of 11.1% in 115 patients with SF where mortality rates were significantly higher in comminuted SFs ( p = 0.045).…”

“…Concomitant injuries alongside rib fractures such as haemothorax and lung contusions were more evident in their analysis of SF patients. [ 14 ] This evidence is also supported by Yakar et al [ 15 ] who identified that MVA was the most common mechanism of injury in their SF patients (66.4%, N = 128) and the most common thoracic pathology accompanying SFs was rib fractures (36%, N = 128). Despite the evidence displaying the prevalence of rib fractures and its associated risk in the context of SF, there is very little evidence to review regarding bilateral rib injury.…”

“…Al-Thani et al . [ 14 ] assessed the presence of rib fractures in patients attending with SF and identified that those with rib fractures were generally older (40.1 years ± 13.6 vs. 37.8 years ± 14.5), more likely to be intubated (33% vs 19%) and have higher chest abbreviated injury scales (AIS) (AIS 2.8 ± 0.6 vs. 2.2 ± 0.5). Concomitant injuries alongside rib fractures such as haemothorax and lung contusions were more evident in their analysis of SF patients.…”

Artificial Bee Colony Algorithm-Based Ultrasound Image Features in the Analysis of the Influence of Different Anesthesia Methods on Lung Air Volume in Orthopedic Surgery Patients

“…Before induction of general anesthesia, high oxygen concentration will make the lung foam disappear; the use of anesthetics and muscle relaxation can cause the patient to relax the muscles in the lungs, resulting in a decrease in the tension of the elastic contractive diaphragm on the lateral side of the chest wall; during the process of anesthesia, increased secretions such as alveoli small airway blockage lead to atelectasis. Under anesthesia, the ventilation and blood perfusion status of patients changes, and the ventilation volume in the middle and lower regions decreases, resulting in the condition of hypoventilation [18,19].…”