[The sterno-vertebral instability - a new classification and therapeutic options]

Sternal fractures in the context of high velocity trauma are commonly referred to as impact injuries. In general, these are considered to be treated conservatively. In the literature, there are only a few studies and a small number of cases. We know that not only high velocity accidents cause combined trauma of sternum and spine, but also low velocity traumas in the elderly are relatively common. How should such combinations of injuries be treated?

Based on 11 patients from the years 2005 to 2013 with different combinations of sternal and spinal injuries, we distinguish the therapeutic approach of ventral, dorsal or combined stabilisation, with the help of a four-column classification of these injuries.

We classify sternovertebral injury into 4 types. First the descendant type with an injury from C I to C VII and sternum, second the horizontal type (T I to T XII and sternum), third the ascendant type (L I to L V and sternum) and fourth a dissociative type. The recommended therapy of the descendant type is dorsoventral stabilisation of the spinal column plus stabilisation of the sternum. The horizontal type should be treated with dorsal stabilisation of the spine and stabilisation of the sternum. The ascendant type should be supplied with dorsoventral stabilisation of the spinal column and conservative therapy of the sternum. In case of the dissociative type one should supply each injury independently.

The literature on sternal injuries and their treatment is low. Combinations of sternum and spine injuries have not yet been processed systematically in literature. Thus, there is no concerted standard of therapeutic options. The very rare occurrence of this injury combination often leads to this injury type being forgotten in the primary evaluation of casualties.