Top

European Journal of Orthopaedic Surgery & Traumatology

Published in:

01-01-2020 | Original Article • THORAX - TRAUMA

Osteosynthesis of sternal fractures with double locking compression plate fixation: a retrospective cohort study

Authors: Nina Kalberer, Herman Frima, Christian Michelitsch, Jan Kloka, Christoph Sommer

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 1/2020

Abstract

Purpose

Sternal fractures are rare injuries and mostly treated non-operatively. In selected cases, internal fixation becomes necessary. No standard operative approach has been determined yet among experts. The aim of this study is to describe our treatment algorithm and results after operative stabilisation of sternal fractures with locking compression plates (LCP), mainly focusing on the functional outcome.

Methods

A retrospective cohort study was conducted. We included all patients after operative stabilisation of a sternal fracture between 2008 and 2016. Endpoints were the functional outcome using the Activities of Daily Living (ADL) score, pain analysed by the numeric rating scale (NRS), breathing ability, complications and implant removal.

Results

Eighteen out of 153 (12%) patients with a sternal fracture underwent operation. Three patients were lost to follow-up. Eleven out of 15 (73%) patients were treated with double straight LCP 3.5 mm implants and 4 (27%) patients with pre-countered LCP 3.5 mm implants. Mean follow-up was 57 months. The median ADL score was 1 (1–4), the median NRS was 0 (0–9), and respiratory complaints scored a median of 1 (1–4). No non-union, hardware failure or implant-related complication occurred. Post-operative complications were pneumonia (20%) and respiratory insufficiency (20%). Implants were removed in 4/15 (27%) patients; three times due to implant-related irritation, once on patient’s request.

Conclusion

Operative stabilisation of sternal fractures with double LCP 3.5 mm provides excellent long-term functional results and seems to be an appropriate option for internal fixation. The rate of post-operative complications is low; however, 27% had a second operation for implant removal.

Odell DD, Peleg K, Givon A et al (2013) Sternal fracture: isolated lesion versus polytrauma from associated extrasternal injuries—analysis of 1,867 cases. J Trauma Acute Care Surg 75(3):448–452CrossRef

Athanassiadi K, Gerazounis M, Moustardas M et al (2002) Sternal fractures: retrospective analysis of 100 cases. World J Surg 26(10):1243–1246CrossRef

Perez MR, Rodriguez RM, Baumann BM et al (2015) Sternal fracture in the age of pan-scan. Injury 46(7):1324–1327CrossRef

Krinner S, Grupp S, Oppel P et al (2017) Do low profile implants provide reliable stability in fixing the sternal fractures as a “fourth vertebral column” in sternovertebral injuries? J Thorac Dis 9(4):1054–1064CrossRef

Harston A, Roberts C (2011) Fixation of sternal fractures: a systematic review. J Trauma 71(6):1875–1879PubMed

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(2):444–450CrossRef

Schmitt S, Krinner S, Langenbach A et al (2017) Analysis on the Age Distribution of Sternum Fractures. Thorac Cardiovasc Surg 66(8):670–677CrossRef

Recinos G, Inaba K, Dubose J et al (2009) Epidemiology of sternal fractures. Am Surg 75(5):401–404PubMed

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(1):22CrossRef

10.

Klei DS, de Jong MB, Öner FC et al (2018) Current treatment and outcomes of traumatic sternal fractures-a systematic review. Int Orthop 43(6):1455–1464CrossRef

11.

Schulz-Drost S, Oppel P, Grupp S et al (2016) Bony injuries of the thoracic cage in multiple trauma: incidence, concomitant injuries, course and outcome. Unfallchirurg 119(12):1023–1030CrossRef

12.

Kälicke T, Frangen TM, Müller EJ et al (2006) Traumatic manubriosternal dislocation. Arch Orthop Trauma Surg 126(6):411–416CrossRef

13.

Nazerali RS, Hinchcliff K, Wong MS (2014) Rigid fixation for the prevention and treatment of sternal complications. Ann Plast Surg 72(Suppl 1):S27–S30CrossRef

14.

Divisi D, Di Leonardo G, Crisci R (2013) Surgical management of traumatic isolated sternal fracture and manubriosternal dislocation. J Trauma Acute Care Surg 75(5):824–829CrossRef

15.

Al-Qudah A (2006) Operative treatment of sternal fractures. Asian Cardiovasc Thorac Ann 14(5):399–401CrossRef

16.

Sommer C (2005) Fixation of transverse fractures of the sternum and sacrum with the locking compression plate system: two case reports. J Orthop Trauma 19(7):487–490CrossRef

17.

Kellam JF, Meinberg EG, Agel J et al (2018) Introduction: fracture and dislocation classification compendium-2018: international comprehensive classification of fractures and dislocations committee. J Orthop Trauma 32(Suppl 1):S1–S10PubMed

18.

Hawker GA, Mian S, Kendzerska T et al (2011) Measures of adult pain: visual analog scale for pain (VAS Pain), numeric rating scale for pain (NRS Pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res (Hoboken) 63(Suppl 11):S240–S252CrossRef

19.

Katz S, Ford AB, Moskowitz RW et al (1963) Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA. 185(12):914–919CrossRef

20.

Hulsmans MH, van Heijl M, Houwert RM et al (2017) High irritation and removal rates after plate or nail fixation in patients with displaced midshaft clavicle fractures. Clin Orthop Relat Res 475(2):532–539CrossRef

21.

von Garrel T, Ince A, Junge A et al (2004) The sternal fracture: radiographic analysis of 200 fractures with special reference to concomitant injuries. J Trauma 57(4):837–844CrossRef

22.

Gloyer MA, Frei HC, Hotz TK et al (2011) Osteosynthesis of traumatic manubriosternal dislocations and sternal fractures with a 3.5/4.0 mm fixed-angle plate (LCP). Arch Orthop Trauma Surg 131(9):1261–1266CrossRef

23.

McKim LH (1943) A method of fixation for fractures of the sternum. Ann Surg 118:158CrossRef

24.

Mayba II (1985) Non-union of fractures of the sternum. J Bone Joint Surg Am 67(7):1091–1093CrossRef

25.

Opie JC (1997) Avoidance of sternal nonunion. Ann Thorac Surg 64(3):888–889PubMed

26.

Schulz-Drost S, Oppel P, Grupp S et al (2015) Surgical fixation of sternal fractures: preoperative planning and a safe surgical technique using locked titanium plates and depth limited drilling. J Vis Exp 5(95):e52124

Title: Osteosynthesis of sternal fractures with double locking compression plate fixation: a retrospective cohort study
Authors: Nina Kalberer
Herman Frima
Christian Michelitsch
Jan Kloka
Christoph Sommer
Publication date: 01-01-2020
Publisher: Springer Paris
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 1/2020
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-019-02526-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Osteosynthesis of sternal fractures with double locking compression plate fixation: a retrospective cohort study

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2020

A porous polymeric–hydroxyapatite scaffold used for femur fractures treatment: fabrication, analysis, and simulation

Orthopedic oncology: What’s new in 2019?

“Tomydesis” might be a reliable technique for lesions of the long head of the biceps tendon associated with rotator cuff tears: a minimum 6-month prospective clinical follow-up study

Oncological and endoprosthetic outcomes of bone sarcoma patients: a nationwide cohort study

Septic arthritis of the lumbar facet joint presenting as spontaneous bacterial peritonitis: a rare case requiring surgical intervention

Luiz Roberto Vialle (ed): AO spine masters series—Volume 10 spinal infections