[Sternal fractures and their surgical treatment].

PURPOSE OF THE STUDY: Sternal fractures occur most frequently in vehicle accidents, then due to falls from a height and by other blunt chest trauma. Most of these injuries are simple, non-displaced fractures only rarely requiring surgical management. Based on a retrospective analysis, the authors present their experience with the treatment of sternal fractures, emphasizing the use of osteosynthesis.

MATERIAL AND

METHODS

A group of 293 patients treated for fresh sternal fractures in the period from 2004 to 2013 were evaluated. Their median age was 47.5 years (range, 2 to 86 years). They were allocated to two groups according to the method of treatment, ie., conservative versus surgical. The two groups were compared in the following characteristics: mechanism and extent of trauma, methods of treating the fracture and associated injuries and troponin-T and myoglobin values.

RESULTS

Of the 293 patients, 16 had surgery (surgical group) and the remaining patients were treated conservatively. Eleven patients (3.8%) had surgery for instability or chest wall deformity. Five patients (1.7%) underwent urgent cardiovascular surgery due to complications of sternum fracture. In the surgical group, comminuted fractures were more frequent (p=0.0003), rib fractures had a higher incidence rate (p=0.0442), concomitant abdominal injuries occurred more often (p=0.0173) and serum levels of troponin-T and myoglobin were higher (p<0.0001 and p=0.0114, respectively) than in the other group.

DISCUSSION: The majority of sternal injuries (90-95%) are non-displaced, simple fractures that heal spontaneously. In complicated fractures, reduction and fragment fixation relieve pain, provide prevention from respiratory complications and make the duration of mechanical ventilation shorter. Our results show that osteosynthesis was mostly indicated in displaced and comminuted fractures or severe chest deformity. Concomitant intra-abdominal injury is caused by a flexion mechanism or an impact on the front of the body. Serious sternal fractures are associated with increased serum levels of troponin-T and myoglobin.

CONCLUSIONS

Plate fixation is a suitable method of stable osteosynthesis in complicated sternal fractures. It shortens the duration of mechanical ventilation and repairs post-traumatic chest wall deformities.