ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Isolated sternal fractures: a hallmark of violent injury
Mehmet Bilgin1, Yiğit Akçalı2, Leyla Hasdıraz1, Fahri Oğuzkaya1
1Departments of Thoracic Surgery, Medicine Faculty of Erciyes University, Kayseri
2Departments of Cardiovascular Surgery, Medicine Faculty of Erciyes University, Kayseri
Background: Sternal fractures are rare injuries compared to fractures of other bones, and their main cause is traffic accidents. We evaluated isolated sternal fractures that were treated by surgical or nonsurgical interventions.

Methods: Forty-seven patients (38 men, 9 women; mean age 38 years; range 27 to 70 years) were treated for isolated sternal fractures. The patients were evaluated in terms of location, shape, and type of fractures, treatment methods, and complications. Posteroanterior and left lateral chest radiograms were used for the diagnosis.

Results: Forty-one patients (87.2%) were injured by a traffic accident and the majority of these patients (n=36) wore a seat belt. Sternal fractures were localized in the mid-gladiolus in 29 patients (61.7%). Five patients had an unseparated sternomanubrial fracture, and four patients had sternal fracture in the lower one-third of the sternum. Seven patients had presternal hematoma. The average time from injury to treatment was 6.3 hours. Four patients (8.5%) had pneumothorax. Electrocardiography showed ST-T changes in nine patients (19.2%). Eight patients were managed by closed manipulation with hyperextension of the spine, and 13 patients with separated and unstable sternal fractures were managed by surgical fixation with steel wiring. No complications or mortality occurred. The mean hospital stay was 8.3 days (range 4 to 13 days).

Conclusion: The management of patients with isolated sternal fractures is usually conservative. However, some patients may require surgery. In order to prevent possible cardiac and cardiovascular complications, electrocardiographic and cardiac enzymatic changes should be monitored.

Keywords : Accidents, traffic; chest pain/etiology; fracture fixation/ methods; sternum/injuries/surgery; wounds, nonpenetrating
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