Surgical Treatment of Sternal Fracture: Case Report and Literature Review

Jorge Pérez-Acosta, MD, MSc^1,2; Orlando Téllez-Almenares, MD, MSc^1,2*; Justo Escalona-Cartaya, MD^1,2; Raúl Calas-Balbuena, MD, MSc^1,2; Olga M. Moreira-Barinaga, MD¹

1Saturnino Lora Provincial Hospital, Santiago de Cuba, Cuba
2University of Medical Sciences of Santiago de Cuba, Santiago de Cuba, Cuba

Orlando Téllez-Almenares, MD, MSc

Saturnino Lora Provincial Hospital, Santiago de Cuba, Cuba; University of Medical Sciences of Santiago de Cuba, Santiago de Cuba, Cuba; E-mail: orlandotellez.al@gmail.com

Received: June 8^th, 2023; Revised: July 10^th, 2023; Accepted: July 14^th, 2023; Published: July 21^st, 2023

Pérez-Acosta J, Téllez-Almenares O, Escalona-Cartaya J, Calas-Balbuena R, Moreira-Barinaga OM. Surgical treatment of sternal fracture: Case report and literature review. Surg Res Open J. 2023; 8(1): 1-6. doi: 10.17140/SROJ-8-129

Copyright

© 2023 by Téllez-Almenares O. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC-BY 4.0)

Sternal fractures are uncommon thoracic trauma that can ensue in isolation or conjunction with other organ injuries, implying more significant morbidity and mortality. These fractures result from diverse aetiological mechanisms, some of which may provoke minor chest wall issues, while others can have deadly outcomes. The sternal fracture’s primary aetiological culprits are direct impact and the upper thoracic region’s compression. Studies reveal that traumatic sternum fractures occur in 8-18% of blunt thoracic and polytrauma victims, whereas they are unusual in open trauma. This report aims to outline the case of a 54-year-old Caucasian male with hypertension and an alcohol consumption history who sustained a direct impact on the anterior thorax after a traffic accident. He experienced severe pain that worsened with movement and coughing, and breathing difficulty. We noticed a painful haematoma and depression with bony crepitus at the sternal body level. Abdominal-pelvic echography indicated no intraabdominal lesions and showed pleural effusion in the left lung base, while thoracic X-rays (lateral and anteroposterior view) and chest computerized tomography (CT) scan exhibited mid-sternum segment displaced fracture and haemothorax. We diagnosed a mid-sternum completely displaced overlapping fracture and a traumatic left haemothorax. Therefore, urgent surgical intervention was required. We performed a minimal-lower pleurotomy and internal fixation to address the fracture. His post-operative recovery was satisfactory. Although various authors advocate X-rays as an effective diagnostic means for sternal fractures, CT uncovers overlooked radiography abnormalities; therefore, CT must be considered in patients’ initial assessment. While most sternal fractures can be treated conservatively, surgery is feasible in displaced fractures.

Trauma remains a global health concern with meaningful repercussions on peoples’ lives and healthcare systems.1,2 The development and mechanisation of industries and vehicles’ widespread use has been determining factors in increased traumas.3 The Swedish Trauma Registry informs that it is one of the leading cause of death and disability in individuals under 45 worldwide, surpassing cancer deaths among young adults.4

Road traffic crashes are a foremost cause of injury, posing a critical matter in numerous nations.2 The World Health Organisation (WHO) conveyed that traffic accidents provoke approximately 1.3 million yearly casualties.5 As per National Trauma Data Bank’s
2016 annual report,6 223,866 motor vehicle accidents ensued in the United States, resulting in 10,343 casualties. A recent Cuban report7 points out that between 2019 and 2020, there were 1,368 fatalities from road traffic accidents, of which 80.8% were male.
Blunt trauma is a common occurrence in motor vehicle collisions and is associated, in most cases, with severe organ damage.1,6,8 In Sweden, blunt injuries account for approximately 90% of all injuries. Blunt thorax traumas (BTT) are the third leading
cause of trauma-related death, preceded only by traffic-related head and abdominal injuries.8

The thorax is one of the most affected regions in motor vehicle accidents. The 2016 National Trauma Data Bank statistics6 logged 1,29,338 thoracic traumas (TT) with AIS>3 with a fatality rate of 9.53. Multiple authors have noted that TT mortality is proximately 25% of all traumatic deaths globally and contributes 25% to mortality from other types of traumas. South Korean research Byun et al1 shows that 33.6%-non-surviving caseload died due to significant chest harm. In contrast, a Cuban study3 states that TT accounts for 4-6% of trauma admissions in Cuba and has a fatality rate of 15%.