Early National Landscape of Surgical Stabilization of Sternal Fractures

Abstract

Background

Operative management of chest wall injuries aims to restore respiratory mechanics and mitigate pulmonary complications. Extensive studies support surgical stabilization of rib fractures (SSRF) for select patients, but role for surgical stabilization of sternal fractures (SSSF) remains unclear. We aimed to understand national prevalence of SSSF and compare outcomes after surgical stabilization and non-operative management of sternal fractures.

Methods

We retrospectively analyzed adult patients (age ≥ 18 years) admitted with sternal fractures after blunt trauma using the 2016 National Trauma Data Bank. We compared odds of inpatient mortality, pneumonia, and respiratory failure for propensity score matched patients (4:1) who underwent non-operative management vs SSSF. We characterized subgroup of patients with concurrent rib and sternal fractures who underwent concomitant SSRF-SSSF.

Results

We identified 14,760 encounters of adults admitted with sternal fractures; 270 (1.8%) underwent SSSF. Compared to matched patients who underwent non-operative management, patients who underwent SSSF had lower odds of mortality (OR [95%CI]: 0.19 [0.06–0.62], p = 0.006). Adjusted for trauma center level, Mantel–Haenszel mortality odds remained lower for patients who underwent SSSF. Odds of pneumonia and respiratory failure were similar between matched groups. Among 46% of patients who had concomitant rib fractures, 0.3% (n = 18) underwent concurrent SSRF-SSSF and these patients survived hospitalization without pneumonia or respiratory failure.

Conclusion

A vast majority of patients who suffer sternal fractures undergo non-operative management. Potential mortality benefit of SSSF and concurrent SSRF-SSSF’s role for commonly concomitant rib and sternal fractures deserve further study. Our preliminary findings call for delineating heterogeneity of sternal fractures and establishing consensus SSSF indications.

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References

  1. 1.

    Knobloch K, Wagner S, Haasper C et al (2006) Sternal fractures occur most often in old cars to seat-belted drivers without any airbag often with concomitant spinal injuries: clinical findings and technical collision variables among 42,055 crash victims. Ann Thorac Surg 82:444–450. https://doi.org/10.1016/j.athoracsur.2006.03.046

    Article  PubMed  Google Scholar 

  2. 2.

    Perez MR, Rodriguez RM, Baumann BM et al (2015) Sternal fracture in the age of pan-scan. Injury 46:1324–1327. https://doi.org/10.1016/j.injury.2015.03.015

    Article  PubMed  Google Scholar 

  3. 3.

    Klei DS, de Jong MB, Öner FC et al (2019) Current treatment and outcomes of traumatic sternal fractures-a systematic review. Int Orthop 43:1455–1464. https://doi.org/10.1007/s00264-018-3945-4

    Article  PubMed  Google Scholar 

  4. 4.

    Zhao Y, Yang Y, Gao Z et al (2017) Treatment of traumatic sternal fractures with titanium plate internal fixation: a retrospective study. J Cardiothorac Surg 12:22. https://doi.org/10.1186/s13019-017-0580-x

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Harston A, Roberts C (2011) Fixation of sternal fractures: a systematic review. J Trauma Acute Care Surg 71:1875–1879. https://doi.org/10.1097/TA.0b013e31823c46e8

    Article  Google Scholar 

  6. 6.

    Divisi D, Di Leonardo G, Crisci R (2013) Surgical management of traumatic isolated sternal fracture and manubriosternal dislocation. J Trauma Acute Care Surg 75:824–829. https://doi.org/10.1097/TA.0b013e3182a686a5

    Article  PubMed  Google Scholar 

  7. 7.

    Kasotakis G, Hasenboehler EA, Streib EW et al (2017) Operative fixation of rib fractures after blunt trauma: a practice management guideline from the eastern association for the surgery of trauma. J Trauma Acute Care Surg 82:618–626. https://doi.org/10.1097/ta.0000000000001350

    Article  PubMed  Google Scholar 

  8. 8.

    Brasel K, Moore E, Albrecht R et al (2017) Western trauma association critical decisions in trauma: management of rib fractures. J Trauma Acute Care Surg 82:200–203. https://doi.org/10.1097/TA.0000000000001301

    Article  PubMed  Google Scholar 

  9. 9.

    Committee on trauma (2016) American college of surgeons. NTDB 2016

  10. 10.

    Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46:399–424. https://doi.org/10.1080/00273171.2011.568786

    Article  Google Scholar 

  11. 11.

    Stata statistical software: release 16 (2019) StataCorp LLC. Coll Station TX

  12. 12.

    Yeh DD, Hwabejire JO, DeMoya MA et al (2014) Sternal fracture—an analysis of the national trauma data bank. J Surg Res 186:39–43. https://doi.org/10.1016/j.jss.2013.08.025

    Article  PubMed  Google Scholar 

  13. 13.

    Oyetunji T, Jackson H, Obirieze A et al (2013) Associated Injuries in traumatic sternal fractures: a review of the national trauma data bank. Am Surg 79:702–705

    Article  Google Scholar 

  14. 14.

    Graeber GM, Nazim M (2007) The anatomy of the ribs and the sternum and their relationship to chest wall structure and function. Thorac Surg Clin 17:473–489. https://doi.org/10.1016/j.thorsurg.2006.12.010

    Article  PubMed  Google Scholar 

  15. 15.

    Mayberry JC, Ham LB, Schipper PH et al (2009) Surveyed opinion of American trauma, orthopedic, and thoracic surgeons on rib and sternal fracture repair. J Trauma 66:875–879. https://doi.org/10.1097/TA.0b013e318190c3d3

    Article  PubMed  Google Scholar 

  16. 16.

    Choi J, Khan S, Hakes NA et al (2020) Prospective study of short-term quality-of-life after traumatic rib fractures. J Trauma Acute Care Surg. https://doi.org/10.1097/TA.0000000000002917

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Beks RB, de Jong MB, Houwert RM et al (2019) Long-term follow-up after rib fixation for flail chest and multiple rib fractures. Eur J Trauma Emerg Surg 45:645–654. https://doi.org/10.1007/s00068-018-1009-5

    Article  PubMed  Google Scholar 

  18. 18.

    Majercik S, Cannon Q, Granger SR et al (2014) Long-term patient outcomes after surgical stabilization of rib fractures. Am J Surg 208:88–92. https://doi.org/10.1016/j.amjsurg.2013.08.051

    Article  PubMed  Google Scholar 

  19. 19.

    Edwards JG, Clarke P, Pieracci FM et al (2020) Taxonomy of multiple rib fractures: results of the chest wall injury society international consensus survey. J Trauma Acute Care Surg 88:e40–e45. https://doi.org/10.1097/TA.0000000000002282

    Article  PubMed  Google Scholar 

  20. 20.

    Clarke PTM, Simpson RB, Dorman JR et al (2019) Determining the clinical significance of the chest wall injury society taxonomy for multiple rib fractures. J Trauma Acute Care Surg 87:1282–1288. https://doi.org/10.1097/TA.0000000000002519

    Article  PubMed  Google Scholar 

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Funding

There was no funding specific to this project. We would like to thank the Neil and Claudia Doerhoff Fund for support of Dr. Choi’s scholarly activities.

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Correspondence to Jeff Choi.

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This study was exempted from review by Stanford University Institutional Review Board.

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Choi, J., Khan, S., Syed, M. et al. Early National Landscape of Surgical Stabilization of Sternal Fractures. World J Surg (2021). https://doi.org/10.1007/s00268-021-06007-5

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