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J Surg Res 2022 May 6;277:310-318. Epub 2022 May 6.

Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia.

Introduction: Damage to the thoracic cage is common in the injured patient, both when the injuries are confined to this single cavity and as part of the overall injury burden of a polytraumatized patient. In a subset of these patients, the severity of injury to the intrathoracic viscera is either underappreciated at admission or blossom over the following 48-72 h. The ability to promptly identify these patients and abrogate complications therefore requires triage of such at-risk patients to close monitoring in a critical care environment. Read More

PLoS One 2022 6;17(5):e0268202. Epub 2022 May 6.

Service d'Accueil des Urgences-SAMU 69, Centre Hospitalier Universitaire Édouard Herriot, Lyon, Hospices Civils de Lyon, France.

Background: Thoracic trauma is a major cause of death in trauma patients and road traffic accident (RTA)-related thoracic injuries have different characteristics than those with non-RTA related thoracic traumas, but this have been poorly described. The main objective was to investigate the epidemiology, injury pattern and outcome of patients suffering a significant RTA-related thoracic injury. Secondary objective was to investigate the influence of serious thoracic injuries on mortality, compared to other serious injuries. Read More

Surg Infect (Larchmt) 2022 May;23(4):321-331

Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.

Surgical stabilization of rib fractures is recommended in patients with flail chest or multiple displaced rib fractures with physiologic compromise. Surgical stabilization of rib fractures (SSRF) and surgical stabilization of sternal fractures (SSSF) involve open reduction and internal fixation of fractures with a plate construct to restore anatomic alignment. Most plate constructs are composed of titanium and presence of this foreign, non-absorbable material presents opportunity for implant infection. Read More

Radiol Case Rep 2022 Jun 20;17(6):2227-2230. Epub 2022 Apr 20.

Department of Interventional Radiology, Saint-Etienne University Hospital, Avenue Albert Raimond, 42055 Saint-Etienne cedex 2, France.

Secondary lesions and hemopathy localized in sternal bone may be responsible for persistent pain and resistant to classical analgesics. Surgical treatment is not applicable in these cases. We report on 2 cases of sternal osteosynthesis by internal cemented screw fixation, under fluoroscopy and CT scan control, without complication and with clear, immediate reduction of pain. Read More

J Feline Med Surg 2022 Apr 26:1098612X221089701. Epub 2022 Apr 26.

Small Animal Referral Hospital Langford Vets, University of Bristol, Bristol, UK.

Objectives: The aim of this study was to determine closure-related complications and outcome after median sternotomy (MS) in cats.

Methods: This was a retrospective, multicentric study. The medical records of cats undergoing MS from six referral hospitals were reviewed (2010-2020). Read More

Turk Gogus Kalp Damar Cerrahisi Derg 2022 Jan 28;30(1):57-65. Epub 2022 Jan 28.

Department of Thoracic Surgery and Lung Transplantation, Health Sciences University, Ankara City Hospital, Ankara, Turkey.

Background: This study aims to evaluate the results of the method we used to treat sternal dehiscence and mediastinitis due to median sternotomy following open heart surgery.

Methods: Between July 2014 and March 2019, a total of 13 patients (8 males, 5 females; mean age: 60.3±2. Read More

Cureus 2022 Mar 6;14(3):e22882. Epub 2022 Mar 6.

Emergency Medicine, Maimonides Medical Center, Brooklyn, USA.

In this case report, point-of-care ultrasound (POCUS) was performed to diagnose a sternal fracture and to perform an ultrasound-guided hematoma block on an elderly patient through which excellent pain control was achieved. POCUS is a valuable tool in expediting the diagnosis of sternal fracture and can be used to safely perform a hematoma block for pain control. Read More

Acta Chir Belg 2022 Apr 8:1-4. Epub 2022 Apr 8.

Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.

Background: Manubriosternal dislocations are a rare entity and frequently associated with thoracic spine fractures and, in minority of cases, with cervical or thoracolumbar fractures.

Methods: Our case represents a 38-year-old male who fell from a height resulting in multiple fractures, amongst others of the first lumbar vertebra. At primary survey and computed tomography scan no manubriosternal injury was apparent. Read More

J Surg Case Rep 2022 Mar 30;2022(3):rjac073. Epub 2022 Mar 30.

Department of Anesthesiology, Guthrie Clinic, Sayre, PA, USA.

Adequate pain control after multisystem trauma including the chest wall is essential for improved patient outcomes, especially with sternum and rib fractures. The thoracic epidural is considered the gold standard in pain management of thoracic injury; however, failure or patchy epidural is not uncommon. Pectointercostal fascial plane block (PIFB) is regularly used in cardiac surgery to provide analgesia to the anterior chest wall; however, there are few reports of PIFB being used as a primary block for the management of thoracic injuries. Read More

Am J Emerg Med 2022 Mar 16. Epub 2022 Mar 16.

Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan. Electronic address:

Eur Rev Med Pharmacol Sci 2022 Feb;26(4):1170-1177

Department of Radiology, Kırşehir Education and Research Hospital, Kırşehir, Turkey.

Objective: This study aims to retrospectively investigate the imaging features of patients with sternum fracture (SF) and concomitant organ injuries. We also aimed to evaluate the potential prognostic effect of skeletal muscle area (TMA) and muscle attenuation (MuA) values.

Patients And Methods: Computed tomography (CT) images of patients with SF were re-evaluated by two observers (Observer-1 and 2). Read More

J Clin Endocrinol Metab 2022 May;107(6):e2438-e2448

Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.

Context: Individualized fracture risk may help to select patients requiring a pharmacological treatment for osteoporosis. FRAX and the Garvan fracture risk calculators are the most used tools, although their external validation has shown significant differences in their risk prediction ability.

Objective And Methods: Using data from the Fracture Risk Brussels Epidemiological Enquiry study, a cohort of 3560 postmenopausal women aged 60 to 85 years, we aimed to construct original 5-year fracture risk prediction models using validated clinical risk factors (CRFs). Read More

Semin Ultrasound CT MR 2022 Feb 15;43(1):51-60. Epub 2021 May 15.

Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA. Electronic address:

Child abuse is a broad term that includes, but is not limited to, physical or emotional harm, neglect, sexual abuse, and exploitation. In 2018 in the United States, there were nearly 700,000 victims of such maltreatment, of which 1700 children died. The majority of deaths occur in infants and toddlers under 3 years of age. Read More

Interact Cardiovasc Thorac Surg 2022 05;34(5):768-774

Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Objectives: Blunt chest trauma after mechanical resuscitation manoeuvres appears to have a significant impact on the often complicated course. Due to a lack of data in the literature, the purpose of this study was to investigate the feasibility and immediate outcome of chest wall stabilization for flail chest in this vulnerable patient population.

Methods: We retrospectively reviewed the medical records of patients after cardiopulmonary resuscitation between January 2014 and December 2018 who were diagnosed with flail chest. Read More

Eur J Trauma Emerg Surg 2022 Feb 7. Epub 2022 Feb 7.

Department of Thoracic Surgery, Magdeburg University Medicine, Leipziger Strasse 44, 39120, Magdeburg, Germany.

Purpose: To evaluate the clinical benefit of surgical stabilization of rib fractures (SSRF) in polytrauma patients with serial rib fractures.

Methods: Retrospective single-center cohort analysis in trauma patients. Serial rib fracture was defined as three consecutive ribs confirmed by chest computer tomography (CT). Read More

Int J Emerg Med 2022 Feb 4;15(1). Epub 2022 Feb 4.

Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.

Background: Leriche syndrome is caused by atherosclerosis and is often characterized by symptoms such as intermittent claudication and numbness and coldness of the lower limbs. Its exact prevalence and incidence are unknown because it is a rare disease. We report a case of Leriche syndrome diagnosed incidentally on trauma pan-scan computed tomography (CT). Read More

Mediastinum 2021 25;5:34. Epub 2021 Dec 25.

Department of Surgery, Division of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, MN, USA.

Objective: Traumatic sternal fractures are injuries most commonly resulting from a direct blow to the anterior chest wall or forced deceleration. The purpose of this review is to define the clinical significance of these injuries, outline their initial evaluation and work up, and review current treatment strategies available and their outcomes.

Background: The diagnosis of traumatic sternal fractures has seen a recent rise, largely due to the increased access to computed tomography (CT) scan. Read More

Am J Emerg Med 2022 05 21;55:229.e1-229.e3. Epub 2022 Jan 21.

Emergency Physician, Delta hospital Roeselare-Menen-Torhout, Belgium.

Cardiac tamponade is a rare but possibly fatal complication of blunt thoracic trauma complicated by a sternal fracture. A delayed presentation of cardiac tamponade days or weeks after initial trauma has been described in a few cases. In these cases, the presumed mechanism of cardiac tamponade is pericardial irritation, caused by osseous fragments of the fractured sternum. Read More

Khirurgiia (Mosk) 2022 (1):93-96

Seredavin Samara Regional Clinical Hospital, Samara, Russia.

One of the most severe forms of blunt chest trauma is multiple floating rib fractures. Incidence of this event is up to 20% of all chest injuries. Mortality rate is about 40%. Read More

Injury 2022 May 19;53(5):1627-1630. Epub 2022 Jan 19.

Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, 55416, USA.

Purpose: This study aims to determine if sternal fracture is a predictor of discharge requiring additional care and mortality.

Methods: Blunt pediatric trauma admissions (<18 years) in the Kid's Inpatient Database (2016) were included in analysis. Weighted incidence of sternal fracture was calculated and adjusted for using survey weight, sampling clusters, and stratum. Read More

J Am Heart Assoc 2022 02 19;11(3):e023949. Epub 2022 Jan 19.

Division of Cardiology University of Washington Seattle WA.

Background Patients resuscitated from out-of-hospital circulatory arrest (OHCA) frequently have cardiopulmonary resuscitation injuries identifiable by computed tomography, although the prevalence, types of injury, and effects on clinical outcomes are poorly characterized. Methods and Results We assessed the prevalence of resuscitation-associated injuries in a prospective, observational study of a head-to-pelvis sudden-death computed tomography scan within 6 hours of successful OHCA resuscitation. Primary outcomes included total injuries and time-critical injuries (such as organ laceration). Read More

Eur J Trauma Emerg Surg 2022 Jan 13. Epub 2022 Jan 13.

Division of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL, 33484, USA.

Purpose: Sternal fractures (SF) are commonly associated with other injuries and their incidence is on the rise. The aim was to evaluate injury characteristics and outcomes in patients with all types of SF after blunt trauma.

Methods: Retrospective analysis of 380 SF patients from two Level 1 trauma centers was performed. Read More

J Am Acad Orthop Surg Glob Res Rev 2022 01 11;6(1). Epub 2022 Jan 11.

From the Stony Brook University Hospital, Department of Orthopaedics, Stony Brook, NY (Dr. Shah, Riordan and Dr. Khan); and the Stony Brook University Renaissance School of Medicine, Stony Brook, NY (Bhan and Pey).

Systemic mastocytosis (SM) is pathologically characterized by the proliferation of mast cells with infiltrates in various organs, almost always including bone marrow, leading to defects in bone remodeling. Osteoporosis and subsequent fragility fractures are the most common and clinically relevant presentation, although pathologic fracture through the focal lytic lesions can also be observed. Here, we report the case of a 54-year-old woman, with a recent history of unexplained severe allergic reactions, presenting with intertrochanteric fracture of the left femur which on careful history, physical and radiological evaluation was determined to be pathological. Read More

Am J Forensic Med Pathol 2022 Mar;43(1):55-59

Tarrant County Office of the Chief Medical Examiner, Fort Worth, TX.

Abstract: Posterior rib fractures are considered suspicious for nonaccidental injury when observed in infants without significant trauma history or underlying bone disease. The biomechanical mechanism postulated for causing posterior rib fractures is anterior/posterior compression of the chest with posterior levering of the rib head over the transverse process of the vertebra creating a focal area of stress. The recommended "2-thumb" cardiopulmonary resuscitation method involves the administrator placing both thumbs on the sternum of the patient, encircling the chest with the hands, and placing the finger tips lateral to the spine. Read More

World J Nucl Med 2021 Oct-Dec;20(4):355-360. Epub 2021 Nov 25.

Department of Nuclear Medicine, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India.

Insufficiency fractures (IFs) can be challenging to diagnose due to varied presentations, and sometimes, it changes the course of treatment, as in cancer patients in whom it has to be differentiated with metastatic disease. We present the role of Technetium 99m methylene diphosphonate (Tc-MDP) bone scan, which is a low-cost, simple to perform, whole body diagnostic investigation in the diagnosis of IFs. This is a retrospective analysis of all patients who underwent a Tc-MDP bone scan in a tertiary care teaching hospital during 2013-2017 and were diagnosed as having an IF on bone scan. Read More

Trauma Case Rep 2022 Feb 23;37:100587. Epub 2021 Dec 23.

Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan.

Background: Massive anterior mediastinal hematoma due to chest compression during cardiopulmonary resuscitation is often caused by internal mammary artery injury. However, critical massive anterior mediastinal hematoma without damage to major blood vessels is extremely rare. We report a case of life-threatening anterior mediastinal hematoma without internal mammary artery injury during extracorporeal cardiopulmonary resuscitation. Read More

Clin Biomech (Bristol, Avon) 2022 02 17;92:105552. Epub 2021 Dec 17.

International Laboratory on Spine Imaging and Biomechanics, France and Canada; Laboratoire de Biomécanique Appliquée-Université Gustave-Eiffel, Aix-Marseille Université, UMR T24, 51 boulevard Pierre Dramard, 13015 Marseille, France.

Background: Direct rear head impact can occur during falls, road accidents, or sports accidents. They induce anterior shear, flexion and compression loads suspected to cause flexion-distraction injuries at the cervical spine. However, post-mortem human subject experiments mostly focus on sled impacts and not direct head impacts. Read More

Injury 2022 Mar 26;53(3):1062-1067. Epub 2021 Dec 26.

Department of Orthopaedic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address:

Study Design: Retrospective analysis.

Objective: This study aimed to identify the prevalence of concomitant thoracic spinal and sternal fractures and factors associated with concomitant fractures.

Summary Of Background Data: The sternum has been implicated in stability of the upper thoracic spine, and both bony structures are included in the stable upper thoracic cage. Read More

Am Surg 2022 May 3;88(5):986-988. Epub 2022 Jan 3.

Department of Surgery, 6823Tower Health, Reading, West Reading, PA, USA.

Chest compression has been a component of cardiopulmonary resuscitation (CPR) since 1960. Performance of high-quality CPR is critical for survival; however, chest compressions are traumatic and may result in injuries such as rib and sternal fractures. Spinal fractures have rarely been reported. Read More