Künt Göğüs Travmasına Bağlı Sternum Fraktürleri: Fraktürlerin Prezentasyon Şekilleri ve Prognoza Etkisi

Abstract

Giriş: Sternum fraktürleri, şiddetli toraks travmasının bir göstergesi olarak kabul edilir. Bu çalışma, sternal fraktürlerin farklı prezantasyon şekillerini ve prognoza olan etkilerini değerlendirmeyi amaçlamaktadır. Gereç ve Yöntemler: Ocak 2018- Ocak 2023 tarihleri arasında künt travmaya bağlı sternum fraktürü tespit edilen 139 hastanın verileri retrospektif olarak değerlendirildi. Olgular izole sternum fraktürü (İSF) (n=57, %41) ve komplike sternum fraktürü (KSF) (n=82, %59) olarak iki gruba ayrıldı. Bulgular: Olguların yaş ortalaması 52,9±12 (minimum=20 yıl, maksimum=80 yıl) idi ve olguların çoğunluğu erkekti (n=99, %71,2). KSF olgularında en sık görülen ek patoloji, %47,5 (n=66) ile kemik fraktürüydü. En sık eşlik eden kemik dışı patoloji, poststernal hematom (n=26, %18,7) idi. Bir olguda mortalite gözlendi (%0,7). Yedi olguda (%5,0) cerrahi sternal fiksasyon uygulandı. İSF grubunda istatistiksel olarak daha fazla nondeplase sternum fraktürü gözlendi (%87,7’ye karşılık %61,0, p=0.001). İSF grubunda yoğun bakım ünitesinde kalış süresi (medyan 1 gün karşılık medyan 3 gün, p=0.04) ve hastanede kalış süresi (medyan 2 gün karşılık medyan 3 gün, p=0.001) daha kısaydı. Deplase sternum fraktürü saptanan hastalarda, hastanede kalış süresi daha uzundu (medyan 4 gün karşılık 2 gün, p=0.001). Sonuç: Sternum fraktürlerinde prognoz, fraktüre eşlik eden patolojilerle ilişkilidir. Sternum fraktürünün komplike olması veya deplase olması hastanede kalış süresini uzatmaktadır. İSF olan olguların hastanede kalış süresi kısadır ve prognozları iyidir.

Keywords

• Göğüs travması
• Sternum fraktürü
• Sternal fiksasyon
• Prognoz

Sternal Fractures Due to Blunt Chest Trauma: Presentation Patterns and Impact on Prognosis

Abstract

Introduction: Sternal fractures are considered indicative of severe thoracic trauma. We aimed to compare the effects of isolated and complicated sternum fractures on clinical prognosis. Materials and Methods: The data of 139 patients with sternum fracture due to blunt trauma between January 2018 and January 2023 were evaluated retrospectively. The cases were divided into two groups as isolated sternal fracture (ISF) (n=57, 41%) and complicated sternum fracture (CSF) (n=82, 59%). Results: The mean age of the cases was 52.9±12 (min=20 years, max=80 years) and the majority of the cases were male (n=99, 71.2%). The most common additional pathology in CSF cases was bone fracture with a rate of 47.5% (n=66). The most common non-osseous pathology accompanying sternal fracture was poststernal hematoma (n=26, 18.7%). Mortality was observed in one case (0.7%). Seven patients (5.0%) underwent surgical sternal fixation. Statistically more nondisplaced sternum fractures were seen in the ISF group (87.7% vs. 61.0%, p=0.001). In the ISF group, both the length of stay in the intensive care unit (median 1 day vs. 3 days, p=0.04) and the hospital stay (median 2 days vs. 3 days, p=0.001) were shorter. Patients with a displaced sternum fracture had a longer hospital stay (median 4 days vs. 2 days, p=0.001). Conclusion: The prognosis in sternum fractures is related to the injuries accompanying the fracture. If the sternum fracture is complicated or displaced, the duration of hospitalization is prolonged. ISF cases have a short length of hospital stay and a good prognosis.

Keywords

• Chest trauma
• Sternum fracture
• Sternal fixation
• Prognosis

References

1. 1. Eghbalzadeh K, Sabashnikov A, Zeriouh M, Choi YH, Bunck AC, Mader N, Wahlers T. Blunt chest trauma: a clinical chameleon. Heart. 2018;104(9):719-724.
2. 2. Fokin AA, Wycech Knight J, Abid AT, Yoshinaga K, Alayon AL, Grady R, Weisz RD, Puente I. Sternal fractures in blunt trauma patients. Eur J trauma Emerg Surg. Published online 2022:1-12.
3. 3. Christian AB, Grigorian A, Nahmias J, Duong WQ, Lekawa M, Joe V, Dolich M, Schubl SD. Comparison of surgical fixation and non-operative management in patients with traumatic sternum fracture. Eur J Trauma Emerg Surg. Published online 2020:1-6.
4. 4. Pumphrey O, Burnside N. Thoracic trauma update. Surg. Published online 2023.
5. 5. Aamir J, Alade B, Caldwell R, Chapman J, Shah S, Karthikappallil D, Williams L, Mason L. Sternal fractures and thoracic injury: an analysis of 288 sternal fractures attending a major trauma centre. Eur J Orthop Surg Traumatol. Published online 2023:1-6.
6. 6. Zhao Y, Yang Y, Gao Z, Wu W, He W, Zhao T. Treatment of traumatic sternal fractures with titanium plate internal fixation: a retrospective study. J Cardiothorac Surg. 2017;12:1-5.
7. 7. Yuan SM. Sternal fractures due to blunt chest trauma. J Coll Physicians Surg JCPSP. 2022;32(12):1591-1596.
8. 8. 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;43:1455-1464.

9. 9. Kara H, Bayir A, Degirmenci S, Yildiran H, Kafali ME, Ak A. Sternal fractures in blunt chest trauma: retrospective analysis of 330 cases. Age. 2022;39:8-84.
10. 10. Sengul AT, Kutlu T, Buyukkarabacak YB, Yetim TD, Bekdemir OS, Ozturk C, Basoglu A. Effects of trauma scores on prognosis in chest traumas. Published online 2012.
11. 11. Doyle JE, Diaz-Gutierrez I. Traumatic sternal fractures: a narrative review. Mediastinum. 2021;5.
12. 12. Son YN, Kim JI, Lee HN, Shin SY. Retrosternal hematoma in sternal fracture for prediction of concomitant injury on chest CT. Acta radiol. 2021;62(12):1610-1617.
13. 13. Hıdır E, Büyükterzi Z. Risk factors of blunt cardiac injury and routine use of echocardiography in sternum fractures. J Surg Arts. 2020;13(2):53-57.
14. 14. Bardakçı O, Akdur O, Karatağ O, Akdur G, Alar T, Beggi H. KÜNT GÖĞÜS TRAVMALARINDA BİLGİSAYARLI TOMOGRAFİ İLK TERCİH OLABİLİR Mİ? Nobel Med. 2018;14:54-59.
15. 15. Celik B, Sahin E, Nadir A, Kaptanoglu M. Sternum fractures and effects of associated injuries. Thorac Cardiovasc Surg. 2009;57(08):468-471.
16. 16. Gao E, Li Y, Zhao T, Guo X, He W, Wu W, Zhao Y, Yang Y. Simultaneous surgical treatment of sternum and costal cartilage fractures. Ann Thorac Surg. 2019;107(2):e119-e120.
17. 17. Galante JM, Rinderknecht TN. Chest Trauma. In: Textbook of Emergency General Surgery: Traumatic and Non-Traumatic Surgical Emergencies. Springer; 2023:727-741.