No Need for Sternal Fixation in Traumatic Sternovertebral Fractures: Outcomes of a 10-Year Retrospective Cohort Study

Abstract

Study Design: Retrospective cohort study. Objectives: Combined sternal and spinal fractures are rare traumatic injuries and present a high risk of spinal and thoracic wall instability. Limited research has addressed the treatment of sternovertebral injuries and biomechanical need for sternal fixation to achieve spinal healing. Methods: A 10-year retrospective cohort study was conducted, including patients with sternovertebral fractures admitted to our level-1 trauma centre between 2007 and 2016. Patients who died during hospital admission, military patients, patients with isolated upper cervical spine or lower lumbar spine fractures, and patients lost to follow-up were excluded. Results: In 10 years, 73 patients with sternovertebral fractures were included. Mean injury severity score was 24 (range 4-57). Most sternal fractures were located in the sternal body and manubrium. Spinal fractures were type A (52%), B (40%), or C (8%), and were located in the subaxial cervical (21%), upper thoracic (16%), thoracic (21%), thoracolumbar (47%) area; 7 patients had spinal fractures at multiple levels. Fourteen patients (19%) had a neurological deficit. A total of 42 patients received conservative and 31 patients received operative spinal treatment. Two patients (3%) underwent primary sternal fixation. Sternal failure rate was 1% and biomechanical spinal failure rate was 8%, there was no difference in treatment failure between surgical and conservative spinal treatment. Associated thoracic injuries did not influence sternal or spinal treatment outcomes. Conclusions: These findings indicate that conservative sternal treatment in presence of spinal fractures is safe and effective. The low spinal treatment failure rates imply that sternal fixation is not necessary to achieve spinal stability.

Current treatment and outcomes of traumatic sternovertebral fractures: a systematic review

“…29 patients (30%) developed a pneumonia during their hospital stay. Six patients (10%) had a wound infection, of whom one patient had a haloframe pin tract infection (pneumonia and wound infection were only reported by Klei [ 2 ]). Median hospital length of stay was 17 days (IQR 8–24 days), but was not reported by Labbe [ 10 ], Regauer [ 26 ], and Jiang [ 11 ].…”

“…Sternovertebral fractures are rare injuries [ 1 , 2 , 15 , 22 ]. Few studies have been published on these injuries and their treatment.…”

“…The majority of patients had spinal fractures of the thoracic and thoracolumbar spine (96%), due to the fact that all studies excluded patients with isolated cervical and lower lumbar fractures. Although the association between sternal and thoracic spinal fractures is widely assumed in literature [ 1 , 4 , 7 – 9 , 12 ], the distribution of spinal fractures over the different spinal regions has not been established unambiguously [ 1 , 2 , 4 – 6 , 13 – 20 ]. For instance, in our own cohort study, 14 out of 87 sternovertebral fracture patients (16%) had only upper cervical and/or lower lumbar fractures [ 2 ].…”

“…Few studies have addressed treatment methods and outcomes of sternovertebral fractures, and most had a small patient population; a retrospective cohort study conducted at our level-1 trauma centre is the largest study to date [ 2 ]. Uniform treatment strategies are lacking.…”

“…Some authors argued that treatment depends on spinal fracture level [ 1 ] or that fixation of both sternal and spinal fractures is imperative for adequate spinal support [ 26 ]. Others postulated that spinal fixation alone is sufficient [ 2 , 10 ].…”