The sternal-rib complex. A possible fourth column in thoracic spine fractures

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Spinal Biomechanics

Background:

• Sternal fractures are common thoracic injuries.
• The structural role of the sternum and ribs in thoracic spine stability is not fully understood.
• Previous research has not established a clear link between sternal fractures and specific spinal injury patterns.

Observation:

• Two cases presented with displaced sternal fractures and initially minimally displaced thoracic spine fractures.
• Patients treated nonoperatively developed significant kyphotic deformity.
• The sternum and rib cage were implicated as a potential "fourth column" of thoracic spine support.

Findings:

• A displaced sternal fracture serves as a significant indicator of a potentially unstable thoracic spine injury.
• Flexion-distraction injuries of the thoracic spine are associated with sternal fractures.
• Failure to recognize this association can lead to progressive spinal deformity.

Implications:

• Clinicians should consider associated thoracic spine injuries in patients with displaced sternal fractures.
• A displaced sternal fracture may necessitate a more aggressive treatment approach for the thoracic spine.
• Understanding the sternum-rib complex as a structural support column can refine trauma assessment and management protocols.