The fourth column of the spine: Prevalence of sternal fractures and concurrent thoracic spinal fractures. Issue 3 (March 2022)

• Record Type: Journal Article
• Authors: Breitenbach, Mitchell; Phan, Amy; Botros, Mina; Paul, David; Molinari, Robert; Menga, Emmanuel; Mesfin, Addisu
• Is Part Of: Injury. Volume 53:Issue 3(2022)
• Page Start: 1062
• Page End: 1067
• Publication Date: 2022-03
• Subjects: Thoracic cage -- Thoracic spinal fracture -- Sternal fracture -- Clavicle fracture -- Fourth column -- Burst fracture -- Scapula fracture -- Rib fracture -- Spine fracture -- Spine trauma; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2021.12.040
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: The thoracic spine and sternum are both part of the anatomical unit known as the "upper thoracic cage", and fractures of these two units can present together Level of thoracic spinal fracture (upper or lower) is related to presence of sternal fracture, P = 0.01 Presence of rib fracture, P < 0.001, scapula fracture, P = 0.01, clavicle fracture, P = 0.01, or any combination of rib, scapula, and clavicle fracture, P = 0.01 are related to presence of sternal fracture Presence of sternal fracture is related to respiratory complication during hospital course, P < 0.001 Abstract: Study design: Retrospective analysis. Objective: This study aimed to identify the prevalence of concomitant thoracic spinal and sternal fractures and factors associated with concomitant fractures. Summary of Background Data: The sternum has been implicated in stability of the upper thoracic spine, and both bony structures are included in the stable upper thoracic cage. High force trauma to the thorax can cause multiple fractures to different upper thoracic cage components. Methods: This is a retrospective analysis of electronic medical record data of patients treated at a Level 1 Trauma Center who underwent surgery for thoracic spinal fracture between 2008–2020. We recorded presence of concomitant sternal fracture, injury characteristics, hospital course data, and demographic information. Results: 107 patients with thoracic spinal fractures had a sternal fracture prevalence of 18.7%. The average age was 53.2 [15–90]. 72 (67.3%) were male and 35 (32.7%) were female, 92 (85.9%) were White, 10 (9.3%) were African American, 3 (2.8%) were Hispanic, and 2 (1.9%) were Asian. The average age of patients with sternal fractures was 48.7 years, compared to those without sternal fractures, 54.3 years ( P = 0.251). Patients with T1-T7 fractures [14 of 48 (29.2%)] had a significantly higher rate of sternal fractures compared to patients with T8-T12 fractures [6 of 59 (10.2%)] ( P = 0.012). Patients with additional rib ( P < 0.001), scapula ( P = 0.01), clavicle fractures ( P = 0.01), and those with multiple other thoracic fractures ( P = 0.01) had significantly higher rates of sternal fractures compared to patients without these. Patients with concomitant sternal fractures [10 of 20 (50.0%)] had a significantly higher rate of respiratory complication during their hospital course than patients without concomitant sternal fracture [40 of 87 (46.0%)] ( P < 0.001). Sex, age, mechanism of injury, fracture morphology, estimated blood loss during surgery, intraoperative complications, post-surgical intubation status, and post-surgical intubation duration were not associated with sternal fractures. Conclusions: The prevalence of concomitant thoracic spinal fracture and sternal fracture in our series is 18.7%. T1-T7 fractures and presence of rib, scapula, and clavicle fractures were significantly associated with the presence of sternal fractures. Presence of concomitant sternal fracture was significantly associated with respiratory complication during hospital course.