Comparison of surgical fixation and non-operative management in patients with traumatic sternum fracture

Abstract

Purpose The incidence of sternal fractures in blunt trauma patients lies between 3 and 7%. The role, timing and indications for surgical management are not well delineated and remain controversial for patients undergoing surgical stabilization of sternum fracture (SSSF). We sought to identify the national rate of SSSF in patients with a sternum fracture hypothesizing patients undergoing SSSF will have a decreased rate of mortality and complications. Methods The Trauma Quality Improvement Program (2015-2016) was queried for patients with sternum fracture. Propensity scores were calculated to match patients undergoing SSSF to patients managed non-operatively in a 1:2 ratio using demographic data. Results From 9460 patients with a sternum fracture, 114 (1.2%) underwent SSSF. After propensity-matching, 112 SSSF patients were compared to 224 patients undergoing non-operative management (NOM). There were no differences in matched characteristics (all p > 0.05). Compared to patients undergoing NOM, patients undergoing SSSF had an increased median length of stay (LOS) (16 vs. 7 days, p < 0.001), ICU LOS (9.5 vs. 5.5 days, p = 0.016) and ventilator days (8 vs. 5, p = 0.035). The SSSF group had a similar rate of ARDS (2.7% vs. 2.2%, p = 0.80), pneumonia (1.8% vs. 0.9%, p = 0.48) and unplanned intubation (8.9% vs. 5.8%, p = 0.29) but a lower mortality rate (2.7% vs. 11.2%, p = 0.008). Conclusion Just over 1% of patients with sternum fracture underwent SSSF in a national analysis. Patients undergoing SSSF had an increased LOS and similar rate of all measured pulmonary complications, however a lower mortality rate compared to patients managed non-operatively.

Management of Blunt Sternal Fractures in a Community-Based Hospital

“…However, in a recent study, compared with nonoperative management, operative sternal fixation had a longer hospital stay, an extended ICU stay, and longer ventilator days. Meanwhile, operative fixation and nonoperative management had a similar rate of pneumonia, adult respiratory distress syndrome, unplanned intubation, and other complications [ 29 ].…”

Impact of Sternal Fixation on Patient Outcomes: A Case Matched Review

“…A recent study examined 338 patients from the Trauma Quality Improvement Program database with sternal fractures (112 in the SF group and 224 in the NOM group) that were propensity match at a ratio of 1:2 14 . In this study, the authors found an increased median ICU and hospital LOS as well as an increase in ventilator days for patients who underwent SF compared with the NOM group 14 . Furthermore, the incidence of ARDS development, pneumonia development, and unplanned intubations were similar between cohorts 14 .…”

Traumatic sternal fractures: a narrative review

“…They found lower mortality in the surgical group (2.7% vs. 11.2%, P=0.008) but increased median length of stay and ventilator days. There was no difference in the incidence of pulmonary complications after propensity score matching ( 49 ). Choi and colleagues ( 50 ) analyzed the 2016 National Trauma Data Bank for patients with traumatic sternal fractures after blunt trauma (n=14,760) and found surgical stabilization was performed in 1.8% of patients (n=270).…”

“…One of the larger series from Zhao et al ( 29 ) of 64 patients with acute fracture and non-union showed decreased pain severity scores and healing in all cases, with a 6 month follow up. Christian et al ( 49 ) queried the Trauma Quality Improvement Program database for patients with sternal fractures (n=9,460) and found that 1.2% of patients underwent surgical stabilization (n=114). They found lower mortality in the surgical group (2.7% vs. 11.2%, P=0.008) but increased median length of stay and ventilator days.…”