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Cardiovascular injuries associated with sternal fractures
M A Rashid1, P Ortenwall, T Wikström
1Department of Surgery, Sahlgrenska University Hospital/Ostra, Gothenburg University, Sweden.
The European Journal of Surgery = Acta Chirurgica
|May 17, 2001
Summary
Sternal fractures do not reliably indicate cardiac or aortic injuries. Widened mediastinum is a better indicator of severe chest trauma and associated injuries, warranting further investigation.
Area of Science:
- Trauma Surgery
- Thoracic Surgery
- Emergency Medicine
Background:
- Sternal fractures are often associated with blunt chest trauma.
- The diagnostic significance of sternal fractures, retrosternal hematomas, and widened mediastinum requires clarification.
Purpose of the Study:
- To determine if sternal fractures indicate cardiac and aortic injuries.
- To differentiate between retrosternal hematomas and widened mediastinum in blunt chest trauma patients.
Main Methods:
- Retrospective study of 418 patients with blunt chest trauma.
- Analysis of patients with sternal fractures (n=29) and those without (n=389).
- Comparison of retrosternal hematomas versus widened mediastinum regarding injury severity and outcomes.
Main Results:
- Retrosternal hematomas were common with sternal fractures, particularly of the sternal body, but did not correlate with associated lesions.
- Widened mediastinum indicated higher injury severity, longer hospital stays, and more associated lesions compared to retrosternal hematomas.
- No serious cardiac or aortic injuries were detected; pain was a significant morbidity after sternal fracture.
Conclusions:
- Sternal fractures, with or without retrosternal hematomas, are not reliable indicators of cardiac and aortic injuries.
- Widened mediastinum remains a significant indicator for further investigation of potentially severe injuries.
- Early operative reduction may be beneficial for sternal fractures to alleviate pain.