Sternal fractures and thoracic injury. A review of 288 sternal fractures attending a major trauma centre

Abstract text (incl. references and figure legends)

Introduction
Sternal fractures (SF) are rare injuries usually associated with significant mechanism of
injury. Concomitant injury with SFs can include damage to the thoracic viscera, resulting in a
sharp rise in morbidity and mortality compared to isolated SFs.

Methods
In this retrospective study, we aim to identify the patients in a single major trauma centre
who sustained SFs, evaluate their concomitant injuries, and identify the incidence of
associated thoracic and mediastinal injury in this group.

Results
Over a 7-year period, 288 patients attended with SFs. The most common concomitant
injuries were Rib fractures (56%), Lung Contusions (31.15%) and Haemothorax (21.88%).
There was an 8% mortality associated with SF. The incidence of cardiac injuries in SFs was low (1.74%). The presence of an SF although may
be an important finding, it is not a marker of clinically significant myocardial injury and
rarely causes death when not associated with other thoracic injuries.

Our patients attended with a mean ISS of 22.49 and 25% of patients with SF attended with
systolic BP of <110 mmHg. The chest was the most severe injured body region in 51% of
patients. This highlights clearly that SF is often associated with severe injuries, particularly
to the chest which can compromise haemodynamic stability.

Conclusion
Sternal Fractures are rare but serious injuries. More investigations should be performed to
determine whether early interventions, for example, rib fixation, chest drain insertion and
appropriate analgesia and oxygen therapy can reduce the risk of mortality and morbidity even further.

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