The Depth of Sternal Fracture Displacement Is Not Associated With Blunt Cardiac Injury

Heidelberg, Laura; Uhlich, Rindi; Bosarge, Patrick L.; Kerby, Jeffrey D.; Hu, Parker

doi:10.1016/j.jss.2018.08.051

Cited by 12 publications

(19 citation statements)

References 14 publications

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“…Complications of thoracic trauma are a risk factor, and sternal fracture is sometimes associated with blunt cardiac injury. However, sternal fracture is not specific for blunt cardiac injury [2] , [3] , and rib fracture does not always cause blunt cardiac injury [3] , [4] . Serum cardiac enzymes (e.g., troponin, creatine kinase-MB fraction) are associated with mortality and the severity of blunt cardiac injury and blunt trauma [5] , [6] .…”

Section: Discussionmentioning

confidence: 98%

Identification of a small pericardial effusion on contrast-enhanced computed tomography indicating cardiac perforation and pericardial injury following blunt trauma: A case report

Esumi

Kaneko

Akama

et al. 2021

Trauma Case Reports

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Blunt trauma may cause cardiac perforation requiring emergency surgical repair. Cardiac perforations are usually diagnosed by the presence of a pericardial effusion on echocardiography. However, cardiac perforations and pericardial effusions are sometimes too small to detect, resulting in underdiagnosis. In this case report, we describe a 22-year-old man who was involved in a traffic accident, admitted in a state of shock, and was initially treated for tension pneumothorax and liver and spleen injuries. His initial computed tomography scans revealed a small region of enhancement, corresponding to a small pericardial effusion, indicative of a cardiac perforation. Thus, an emergency median sternotomy was performed. He was diagnosed with perforation of the left atrial ear and right atrium, which were repaired surgically. His liver and spleen injuries were also treated, and the patient was discharged 44 days after admission. The detection of a small pericardial effusion on enhanced computed tomography enabled rapid diagnosis of a cardiac perforation and ensured emergency surgical repair could be performed as soon as possible. Learning objectives To acknowledge the difficulty of diagnosing cardiac perforation in patients with pericardial injury, based on conventional signs of blunt cardiac injury, such as sternal fracture, serum cardiac enzymes, and hemothorax. To recognize that a small pericardial effusion on enhanced computed tomography scans is an important finding that should raise suspicion of cardiac perforation and pericardial injury.

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Section: Discussionmentioning

confidence: 98%

Identification of a small pericardial effusion on contrast-enhanced computed tomography indicating cardiac perforation and pericardial injury following blunt trauma: A case report

Esumi

Kaneko

Akama

et al. 2021

Trauma Case Reports

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show abstract

“…The study concluded that displacement can indicate the severity and prognosis of the fracture and associated injuries. However, Heidelberg, Uhlich [ 26 ] reported that displacement cannot predict fracture displacement and its severity. A recent study conducted by Yakar, Baykan [ 27 ] on 128 sternal fracture patients showed that car traffic accidents are the most common cause of these accidents.…”

Section: Discussionmentioning

confidence: 99%

A retrospective study on the cardiac assessment of isolated sternal fracture patients based on radiographic and clinical outcomes

Ahmadinejad

Pak

Soltanian

et al. 2021

Annals of Medicine &Amp; Surgery

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Objective Sternal fracture may be associated with major and serious injuries. In this study, the complications associated with isolated sternal fracture in trauma patients are evaluated based on radiographic and cardiac findings. Methods This retrospective study was performed on patients with isolated sternal fractures admitted to the emergency department of (XXX) Madani Educational-Medical. Data regarding demographic information, mechanism of trauma, length of hospitalization, electrocardiography (ECG), cardiac enzyme, and chest radiography were recorded in the questionnaire for each patient. Results The mean age of patients 41.2 + 11.04 years and 63.9% were male. The most common cause of the trauma was car accidents in 41% (25 cases). The mean duration of hospitalization was 1.54 ± 0.90 days. The mechanism of trauma was not associated with x-ray and computed tomography findings, p = 0.53 and p = 0.86, respectively. ECG findings were significantly related to x-ray and computed tomography outcomes, p < 0.001, respectively. Conclusion Patients with isolated sternal fracture with displacement >0.5 cm and hematoma are likely to require cardiac consultation.

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“…In a retrospective observational study with 169 patients with blunt thoracic trauma, it was reported that the incidence of blunt cardiac injury was quite high (50%) (8). In another study in which 1,867 patients were evaluated using Israeli national trauma records, it was reported that 1.8% of the patients had cardiac contusion or laceration, but this rate was very low in isolated sternal fractures (3). In the present study, we did not observe any significant difference between the groups in terms of ECHO findings and cardiac enzyme values and both location of fracture (manubrium or corpus) and whether it is displaced.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting discharge of patients with sternal fractures

Üstsoy

Özçete

et al. 2021

Ege Tıp Dergisi

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Aim: Sternal fractures, especially those due to motor vehicle accidents, are encountered in emergency department. There are no clear recommendations on discharge of patients with isolated sternal fractures from the emergency department. In this study, we aimed to examine the relationship between fracture type and severity of injury as well as factors affecting the decision of early discharge in case of sternal fractures detected in the emergency department. Materials and Methods: Patients who presented to the emergency department with trauma between 2014 and 2019 were retrospectively analyzed. Demographic characteristics, trauma mechanisms, additional injuries, injury severity scores, location of sternal fracture and displacement status, echocardiography findings, troponin I values, electrocardiography findings, duration of emergency department and hospital stay, and 30-day mortality of trauma patients aged above over 18 years with sternal fractures on thorax computed tomography included in the study were evaluated. Results: The mean age of 184 patients who were diagnosed with sternal fractures during the 5-year period was 49.9 ± 16.6 years, and 75.5% (n=139) of them were males. On examining the mechanisms of trauma, we found that the most common cause (63.5%; n=117) was motor vehicle accidents. The most common concomitant injuries were rib fractures (56.5%; n=104) and spinal fractures (44%; n=81). It was found that 73.9% (n=136) of sternal fractures were localized in the corpus and 63% (n=116) were non-displaced. It was determined that 33% (n = 61) of the patients were discharged from the emergency department, the mean duration of emergency department stay was 28.3 ± 24.3 hours, and the mean total hospitalization time was 9.8 ± 20.1 days. There was a significant relationship between the time to discharge with injury severity scores (ISS) and troponin I values of the patients. Conclusion:It should be noted that additional life-threatening injuries may be encountered more often in patients presenting with a high injury severity score (>15) and with a manubrium sterni fracture. In sternal fractures, early discharge from the emergency department can be considered in patients with a low injury severity scores (≤15) in whom no abnormal findings are detected in a follow-up performed with echocardiography, troponin I, electrocardiography, and constant monitoring.

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The Depth of Sternal Fracture Displacement Is Not Associated With Blunt Cardiac Injury

Cited by 12 publications

References 14 publications

Identification of a small pericardial effusion on contrast-enhanced computed tomography indicating cardiac perforation and pericardial injury following blunt trauma: A case report

Identification of a small pericardial effusion on contrast-enhanced computed tomography indicating cardiac perforation and pericardial injury following blunt trauma: A case report

A retrospective study on the cardiac assessment of isolated sternal fracture patients based on radiographic and clinical outcomes

Factors affecting discharge of patients with sternal fractures

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