M. Gomez2,5, A. T. Abid3,4, K. Yoshinaga3,4, A. L. Alayon3,4, R. Grady3,4, J. Wycech2,4, A. A. Fokin3,4, I. Puente2,3,4,5 4Delray Medical Center,Trauma Services,Delray Beach, FL, USA 5Florida International University,Herbert Wertheim College Of Medicine,Miami, FL, USA 2Broward Health Medical Center,Trauma Services,Fort Lauderdale, FL, USA 3Florida Atlantic University,Charles E Schmidt College Of Medicine,Boca Raton, FL, USA
Introduction:
Sternal fractures (SF) are rare and occur in 2% of patients with blunt injuries to the chest. There is scarcity of data related to the analysis of SF in relation to different parts of the sternum. The goal of this study was to delineate characteristics and to compare outcomes in patients with a manubrium fracture (MF) versus sternal body fracture (SB).
Methods:
This IRB approved retrospective cohort study included 389 adult patients with radiologically confirmed SF who were treated at two level I trauma centers from 2015 to 2020. Patients were divided and compared based on types of SF: MF (n=103) and SB (n=286). Analyzed variables included: age, mechanism of injury (MOI), Injury Severity Score (ISS), Glasgow Coma Scale (GCS), SF displacement, concomitant fractures of ribs, clavicle and vertebrae, retrosternal hematoma, sternal surgical intervention rates, tracheostomy rates, ICU admissions, ICU length of stay (ICU LOS), hospital length of stay (HLOS), and mortality.
Results:
MF fractures were observed in 26.5% of patients with SF. MF mean age was 62.1 and SB was 61.2, with geriatric patients constituting about half of both groups (~50%). Main MOI in both groups was a motor vehicle collision (82%). Patients in both groups had similar ISS (14.2 vs 13.3, p=0.4) and GCS (13.9 vs 13.8, p=0.8). MF and SB had comparable rates of displaced fractures (20.4% vs 29.4%, p=0.1) and retrosternal hematomas (28.2% vs 25.2%, p=0.6). Concomitant fractures were significantly more common in MF than in SB (77.7% vs 61.9%, p=0.004) [Fig. 1]. Incidence of concomitant rib fractures was significantly higher in MF patients (58.3% vs 39.2%, p=0.001), with MF having higher rates of first and/or second ribs fractured (33.0% vs 13.6%, p<0.001). Concomitant fractures of clavicle (12.6% vs 9.1%), scapula (2.9% vs 3.5%), and vertebrae (44.7% vs 37.1%) were comparable in both groups, all p>0.2. Rates of sternal plating (9.7% vs 11.2%), tracheostomy (8.7% vs 5.9%), ICU admissions (56.3% vs 54.5%), ICU LOS (8.2 vs 6.5 days), and HLOS (10.6 vs 9.7 days) were not statistically different between MF and SB, with all p>0.2. Patients in both groups had similar mortality rates (6.8% vs 8.7%, p=0.5) with at least half of the patients discharged either to home or to home with service. Only 15 patients had dual fractures (MF+SB), which corresponded to 3.7% of all patients with SF, and were not analyzed in this study.
Conclusion:
Manubrial fractures are observed in approximately a quarter of patients with sternal fractures. Manubrium fractures are accompanied more often by upper rib fractures. Due to the location of the subclavian vessels and brachial plexus, caution should be exercised in patients with a manubrium fracture.
