Vertebral fractures and concomitant fractures of the sternum

Abstract

From October 1996 to August 2001, 721 patients with vertebral fractures were admitted to our unit. Ten patients suffered from vertebral fractures and concomitant sternal fractures. The clinical notes and plain film radiographs of these patients were studied. The average age of the patients was 37 (20-69) years. Nine had been involved in road traffic accidents. Three patients had fractures of the cervical spine, six of the upper thoracic spine (T1-T6) and one had a lumbar spine fracture. The extra-thoracic fracture group included two patients with neurological compromise and two patients who were neurologically intact. The entire upper thoracic fracture group suffered neurological compromise, with four patients suffering complete neurological deficit. In addition, four of these patients suffered potentially life-threatening intra-thoracic injuries. The relative severity of the neurological compromise and the attendant injuries in the upper thoracic fracture group offers compelling evidence in support of the "fourth column" theory, as expressed by Berg [Berg EE (1993), The sternal-rib complex. A possible fourth column in thoracic spine fractures. Spine 18(13):1916-1919].

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

“…Assessment of patients with spinal or thoracic trauma requires an awareness of different associated injury patterns 4 . The combination of sternal and vertebral fractures 4 remains a challenge for clinicians because of its rareness, and is easily overlooked in patients with multiple injuries.…”

“…The combination of sternal and vertebral fractures 4 remains a challenge for clinicians because of its rareness, and is easily overlooked in patients with multiple injuries. This may be due to the fact that the upper thoracic region is difficult to explore on standard chest and spinal radiographs 1 and/or that many of these lesions are not suspected or not given much importance as isolated fractures of the sternum are mostly benign 7,8 and may not require special treatment.…”

“…This may be due to the fact that the upper thoracic region is difficult to explore on standard chest and spinal radiographs 1 and/or that many of these lesions are not suspected or not given much importance as isolated fractures of the sternum are mostly benign 7,8 and may not require special treatment. Nevertheless, it is important to consider that enormous forces are needed to result in this type of lesions, thus making it necessary to rule out any other concomitant injuries such as spinal cord injury, hemopneumothorax, heart or pulmonary contusion 1,4,9 . Therefore, in order to exclude associated injuries, careful clinical examination is important while approaching a patient with an alleged isolated sternal fracture 7 .…”

“…Their incidence remains uncertain and probably underestimated 3,4 . These injuries may result in devastating consequences because of high levels of neurological compromise and severe concomitant injuries 1 .…”

“…These injuries may result in devastating consequences because of high levels of neurological compromise and severe concomitant injuries 1 . The stability of the upper thoracic spine is supplemented by the sternum and rib cage 5 , thus the combination of these two fractures may result in severe instability of the spine 4 . For this reason, failure to recognize these lesions at initial work-up may lead to chronic pain and progressive kyphotic deformity 1,6 .…”