Traumatic sternal injury in patients with rib fracture: A single-center experience
Hassan Al-Thani1, Gaby Jabbour1, Ayman El-Menyar2, Bianca M Wahlen3, Mohammad Asim4, Husham Abdelrahman1, Syed Nabir5, Hisham Al-Jogol1, Ismail Mahmood1, Ahmed El-Faramawy1, Ashok Parchani1, Ibrahim Afifi1, Ruben Peralta1
1 Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
2 Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital; Department of Medicine, Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
3 Department of Anesthesia, Hamad General Hospital, Doha, Qatar
4 Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
5 Department of Radiology, Hamad General Hospital, Doha, Qatar
Dr. Ayman El-Menyar
Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital P. O. Box 3050, Doha
Source of Support: None, Conflict of Interest: None
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.