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Int J Crit Illn Inj Sci. 2019 Apr-Jun;9(2):75-81. doi: 10.4103/IJCIIS.IJCIIS_67_18.

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

Author information

1
Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.
2
Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar.
3
Department of Medicine, Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
4
Department of Anesthesia, Hamad General Hospital, Doha, Qatar.
5
Radiology, Hamad General Hospital, Doha, Qatar.

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.

KEYWORDS:

Clinical presentation; outcomes; rib fractures; sternal injury

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