Fractures of the upper transthoracic cage
J-L Labbe1, O Peres, O Leclair
1Service de Chirurgie, Orthopédique CHT, New Caledonia, Melanesia. jl.labbe@cht.nc
The Journal of Bone and Joint Surgery. British Volume
|December 19, 2008
Summary
Fractures of the upper transthoracic cage, combining sternal and upper thoracic spine injuries, are challenging but identifiable with systematic examination. Early stabilization or close follow-up is crucial for these unstable high-energy traumas.
Area of Science:
- Trauma Surgery
- Orthopedic Surgery
- Radiology
Background:
- Indirect sternal fractures combined with upper thoracic spinal injuries are uncommon and often overlooked.
- Previous terminology like 'associated fractures' does not fully capture the anatomical unity of these injuries.
Observation:
- The study reviewed 11 patients with combined sternal and upper thoracic spinal injuries between 2003 and 2006.
- These injuries are frequently associated with severe concomitant trauma, necessitating advanced imaging.
- Key injury sites identified were the T4-T5 level and the manubriosternal joint.
Findings:
- The term 'fractures of the upper transthoracic cage' is proposed as a more accurate description for these combined injuries.
- Systematic clinical and radiological assessment is essential for accurate diagnosis.
- Computed tomography (CT) with contrast and reconstruction is vital post-resuscitation to identify all lesions.
Implications:
- Prompt and accurate diagnosis of upper transthoracic cage fractures is critical.
- These unstable fractures require timely management, including posterior stabilization and fusion or vigilant conservative follow-up.
- Improved understanding and terminology can enhance clinical recognition and patient outcomes.
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