Is hospitalization necessary in isolated traumatic sternal fractures?

Abstract

Objectives: Clinical characteristics, follow-up and treatment outcomes of patients with isolated traumatic sternal fracture were presented and our clinical experiences on these patients were shared.

Methods: Between January 2010 and December 2017, a total of 87 patients with isolated traumatic sternal fracture who were admitted to the emergency department and were hospitalized, were included in this observational cohort study. Medical data of these patients were collected from hospital records and then were retrospectively reviewed.

Results: There were 65 (74.7%) male and 22 (25.3%) female patients. Mean age was 42.4 ± 13.7 years (range: 17-83). The most common etiological reason was traffic accident in vehicle. Sternal fractures were localized at corpus in 64 (73.6%) patients and at manubrium in 23 (26.4%) patients. The most common concomitant pathology was rib fracture with a ratio of 23% (20 patients). Mean length of hospital stay of patients was 3.1 ± 0.8 days. During the hospitalization period, no evidence of cardiac injury was observed in any patient.

Conclusions: In view of rising healthcare costs and increasing demand for acute hospital and intensive care beds, it is crucial to determine hospitalization criteria for cases with traumatic sternal fracture. We believe that the hospitalization is not necessary in isolated traumatic sternal fractures where there is no other major injury.

Keywords

• Sternal fracture
• trauma
• treatment
• hospitalization

References

1. 1. Brookes J, Dunn R, Rogers I. Sternal fractures: a retrospective analysis of 272 cases. J Trauma 1993;35:46-54.
2. 2. Athanassiadi K, Gerazounis M, Moustardas M, Mataxas E. Sternal fractures: retrospective analysis of 100 cases. World J Surg 2002;26:1243-6.
3. 3. Turhan K, Çakan A, Özdil A, Çağırıcı U. Traumatic sternal fractures: diagnosis and management. Ege Tıp Dergisi 2010;49:107-11.
4. 4. Acıpayam A. Our experiences in traumatic sternal fractures and treatment. KSU Tıp Fak Derg 2016;11:33-5.
5. 5. Guska S, Pilav I, Musanovic S. Clinical significance of isolated sternal fracture. Med Arh 2010;64:17-21.
6. 6. Dua A, McMaster J, Desai PJ, Desai SS, Kuy S, Mata M, et al. The association between blunt cardiac injury and isolated sternal fracture. Cardiol Res Pract 2014;2014:629687.
7. 7. Wedde TB, Quinlan JF, Khan A, Khan HJ, Cunningham FO, McGrath JP. Fractures of the sternum: the influence of noninvasive cardiac monitoring on management. Arch Orthop Trauma Surg 2007;127:121-3.
8. 8. Khoriati AA, Rajakulasingam R, Shah R. Sternal fractures and their management. J Emerg Trauma Shock 2013;6:113-6.

9. 9. Engin G, Yekeler E, Güloğlu R, Acunaş B, Acunaş G. US versus conventional radiography in the diagnosis of sternal fractures. Acta Radiol 2000;41:296-9.
10. 10. Klei DS, de Jong MB, Öner FC, Leenen LPH, van Wessem KJP. Current treatment and outcomes of traumatic sternal fractures-a systematic review. Int Orthop 2019;43:1455-64.
11. 11. Molina JE. Evaluation and operative technique to repair isolated sternal fractures. J Thorac Cardiovasc Surg 2005;130:445-8.
12. 12. Harston A, Roberts C. Fixation of sternal fractures: a systematic review. J Trauma 2011;71:1875-9.
13. 13. Ata Y, Aydın U, As AK, Özsin KK, Fındık O, Türk T. Sternal cable wires for sternal closure in moderately or extremely obese patients undergoing cardiac surgery. Eur Res J 2018;4:308-13.
14. 14. Wiener Y, Achildiev B, Karni T, Halevi A. Echocardiogram in sternal fracture. Am J Emerg Med 2001;19:403-5.
15. 15. Kumbasar U, Tokat AO, Karasu S, Çakmak H, Tokat S, Uzun HA, et al. Sternal fractures: retrospective analysis of 55 cases. Ankara Üniversitesi Tıp Fakültesi Mecmuası 2012;65:125-8.
16. 16. Uluşan A, Karakurt Ö. Cardiac findings of sternal fractures due to thoracic trauma: a five-year retrospective study. Ulus Travma Acil Cerrahi Derg 2018;24:249-54.
17. 17. Korkmaz UTK, Taşlıgıl C, Bayraktarlı RY, Kısaoğlu O. Left axillary artery pseudoaneurysm developing 1 year after a stab wound. Med J Islamic World Acad Sci 2018;26:23-5.
18. 18. Racine S, Émond M, Audette-Côté JS, Le Sage N, Guimont C, Moore L, et al. Delayed complications and functional outcome of isolated sternal fracture after emergency department discharge: a prospective, multicentre cohort study. CJEM 2016;18:349-57.