Original Article
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

https://doi.org/10.1016/j.athoracsur.2006.03.046Get rights and content

Background

The incidence and treatment of sternal fractures caused by traffic accidents is of increasing importance to ensure best possible outcomes.

Methods

Analysis of technical indicators of the collision, preclinical, and clinical data of patients with sternal fractures from 1985 to 2004 among 42,055 injured patients was assessed by an Accident Research Unit. Two time groups were categorized: 1985 to 1994 (group A) versus 1995 to 2004 (group B).

Results

Of 42,055 patients, 267 (0.64%) suffered a sternal fracture. Regarding the vehicle type, the majority occurred after car accidents in 0.81% (251 of 31,183 patients), followed by 0.19% (5 of 2,633 patients) driving motorbike, and 0.11% (4 of 3,258 patients) driving a truck. Ninety-one percent wore a safety belt. Only 13% of all passengers suffering a sternal fracture had an airbag on board (33 of 255 car/trucks), with an airbag malfunction in 18%. The steering column was deformed in 39%, the steering wheel in 36%. Cars in the recent years were significantly older (group B, 7.67 ± 5 years, versus group A, 5.88 ± 5 years; p = 0.003). Cervical spine injuries are frequent (23% versus 22%), followed by multiple rib fractures (14% versus 12%) and lung contusions (12% versus 11%). We found 9 of 146 (6%) and 3 of 121 patients (3%) with heart contusion among the 267 sternal fractures. Maximal abbreviated injury scale score was 2.56 ± 1.3 versus 2.62 ± 1.3 (group A versus B, p = 0.349). Eighteen percent of patients were polytraumatized, with 11.2% dying at the scene, 2.3% in the hospital.

Conclusions

Sternal fractures occur most often in old cars to seat-belted drivers often without any airbag. Severe multiple rib fractures and lung contusion are concomitant injuries in more than 10% each, indicating the severity of the crash. Over a 20-year period, the injury severity encountered was not different, with 18% polytrauma patients suffering sternal fractures.

Section snippets

Material and Methods

In a statistical retrospective analysis of car collision files from January 1, 1985, to December 31, 2004, the incidence and mechanism of 267 sternal fractures among a total number of 42,055 injured patients involved in a vehicle accident were examined. Regarding the data used from this governmental database, the local ethical committee agreed to use the data without the individual consent of each patient; all data were used anonymously. The accident files had been prepared by scientific teams

Results

In all, 42,055 injured patients were included in this study from 1985 to 2004, where technical and medical information was available for assessment. Of these, 267 patients (0.64%) suffered a sternal fracture, and 41,788 patients were injured in a traffic accident and assessed without a sternal fracture. The distribution regarding the type of vehicle in sternal fractures is displayed in Table 1, demonstrating cars as the main vehicle involved in sternal fractures.

Comment

Sternal fractures occur most often in old cars to seat-belted drivers. Severe multiple rib fractures and lung contusion are concomitant injuries in more than 10%, indicating the severity of the crash. Eighteen percent of all patients having a sternal fracture were classified as polytrauma patients, with an overall survival rate of 86.1%. We found that 11.2% die at the scene, and we found a 30-day mortality rate of 2.3%.

These data reveal that sternal fractures oftentimes are associated with

References (20)

  • J.M. Lund et al.

    Multiple thoracic spine wedge fractures with associated sternal fracturean unstable combination

    Injury

    (2001)
  • J.T. Sturm et al.

    Does sternal fracture increase the risk for aortic rupture?

    Ann Thorac Surg

    (1989)
  • S. Hendrickson et al.

    Sternal plating for the treatment of sternal non-union

    Ann Thorac Surg

    (1996)
  • E. Arajärvi et al.

    Chest injuries sustained in severe traffic accidents by seatbelt wearers

    J Trauma

    (1989)
  • A. Mahlfeld et al.

    Ultrasound diagnosis of sternum fractures

    Zentralbl Chir

    (2001)
  • J. Alkadhi et al.

    Accuracy and time efficiency for the detection of thoracic cage fracturesvolume rendering compared with transverse computed tomography images

    J Comput Assist Tomogr

    (2004)
  • G.T. Loo et al.

    Airbag protection versus compartment intrusion effect determines the pattern of injuries in multiple trauma motor vehicle crashes

    J Trauma

    (1996)
  • M. Richter et al.

    Correlation between crash severity, injury severity, and clinical course in car occupants with thoracic traumaa technical and medical study

    J Trauma

    (2001)
  • T. Von Garrel et al.

    The sternal fractureradiographic analysis of 200 fractures with special reference to concomitant injuries

    J Trauma

    (2004)
  • K. Athanassiadi et al.

    Sternal fracturesretrospective analysis of 100 cases

    World J Surg

    (2002)
There are more references available in the full text version of this article.

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    Citation Excerpt :

    Thoracic traumas are associated with a significant number of mortality and morbidities since it includes vital organs like the lungs and the heart [2,3]. Isolated sternal fractures are caused by blunt trauma and are benign, however, depending on the nature and the severity of the fracture [4], patients are required to be assessed for supporting injuries [5,6]. Among trauma patients, 0.33% patients are reported with sternal fractures [7].

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Both authors contributed equally to this work.

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