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Original Articles
- Radiologic assessment of the optimal point for tube thoracostomy using the sternum as a landmark: a computed tomography‐based analysis
- Jaeik Jang, Jae-Hyug Woo, Mina Lee, Woo Sung Choi, Yong Su Lim, Jin Seong Cho, Jae Ho Jang, Jea Yeon Choi, Sung Youl Hyun
- J Trauma Inj. 2024;37(1):37-47. Published online February 23, 2024
- DOI: https://doi.org/10.20408/jti.2023.0058
- 780 View
- 12 Download
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Abstract
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Supplementary Material - Purpose
This study aimed at developing a novel tube thoracostomy technique using the sternum, a fixed anatomical structure, as an indicator to reduce the possibility of incorrect chest tube positioning and complications in patients with chest trauma.
Methods
This retrospective study analyzed the data of 184 patients with chest trauma who were aged ≥18 years, visited a single regional trauma center in Korea between April and June 2022, and underwent chest computed tomography (CT) with their arms down. The conventional gold standard, 5th intercostal space (ICS) method, was compared to the lower 1/2, 1/3, and 1/4 of the sternum method by analyzing CT images.
Results
When virtual tube thoracostomy routes were drawn at the mid-axillary line at the 5th ICS level, 150 patients (81.5%) on the right side and 179 patients (97.3%) on the left did not pass the diaphragm. However, at the lower 1/2 of the sternum level, 171 patients (92.9%, P<0.001) on the right and 182 patients (98.9%, P= 0.250) on the left did not pass the diaphragm. At the 5th ICS level, 129 patients (70.1%) on the right and 156 patients (84.8%) on the left were located in the safety zone and did not pass the diaphragm. Alternatively, at the lower 1/2, 1/3, and 1/4 of the sternum level, 139 (75.5%, P=0.185), 49 (26.6%, P<0.001), and 10 (5.4%, P<0.001), respectively, on the right, and 146 (79.3%, P=0.041), 69 (37.5%, P<0.001), and 16 (8.7%, P<0.001) on the left were located in the safety zone and did not pass the diaphragm. Compared to the conventional 5th ICS method, the sternum 1/2 method had a safety zone prediction sensitivity of 90.0% to 90.7%, and 97.3% to 100% sensitivity for not passing the diaphragm.
Conclusions
Using the sternum length as a tube thoracostomy indicator might be feasible. -
Summary
- A decade of treating traumatic sternal fractures in a single-center experience in Korea: a retrospective cohort study
- Na Hyeon Lee, Seon Hee Kim, Jae Hun Kim, Ho Hyun Kim, Sang Bong Lee, Chan Ik Park, Gil Hwan Kim, Dong Yeon Ryu, Sun Hyun Kim
- J Trauma Inj. 2023;36(4):362-368. Published online November 30, 2023
- DOI: https://doi.org/10.20408/jti.2023.0027
- 710 View
- 34 Download
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Abstract
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- Purpose
Clinical reports on treatment outcomes of sternal fractures are lacking. This study details the clinical features, treatment approaches, and outcomes related to traumatic sternal fractures over a 10-year period at a single institution.
Methods
A retrospective cohort study was conducted of patients admitted to a regional trauma center between January 2012 and December 2021. Among 7,918 patients with chest injuries, 266 were diagnosed with traumatic sternal fractures. Patient data were collected, including demographics, injury mechanisms, severity, associated injuries, sternal fracture characteristics, hospital stay duration, mortality, respiratory complications, and surgical details. Surgical indications encompassed emergency cases involving intrathoracic injuries, unstable fractures, severe dislocations, flail chest, malunion, and persistent high-grade pain.
Results
Of 266 patients with traumatic sternal fractures, 260 were included; 98 underwent surgical treatment for sternal fractures, while 162 were managed conservatively. Surgical indications ranged from intrathoracic organ or blood vessel injuries necessitating thoracotomy to unstable fractures with severe dislocations. Factors influencing surgical treatment included flail motion and rib fracture. The median length of intensive care unit stay was 5.4 days (interquartile range [IQR], 1.5–18.0 days) for the nonsurgery group and 8.6 days (IQR, 3.3–23.6 days) for the surgery group. The median length of hospital stay was 20.9 days (IQR, 9.3–48.3 days) for the nonsurgery group and 27.5 days (IQR, 17.0 to 58.0 days) for the surgery group. The between-group differences were not statistically significant. Surgical interventions were successful, with stable bone union and minimal complications. Flail motion in the presence of rib fracture was a crucial consideration for surgical intervention.
Conclusions
Surgical treatment recommendations for sternal fractures vary based on flail chest presence, displacement degree, and rib fracture. Surgery is recommended for patients with offset-type sternal fractures with rib and segmental sternal fractures. Surgical intervention led to stable bone union and minimal complications. -
Summary
- Sternal Fracture Fixation with a Steel Wire: The New “Timala” Technique
- Rabindra Bhakta Timala, Nirmal Panthee
- J Trauma Inj. 2021;34(3):170-176. Published online September 30, 2021
- DOI: https://doi.org/10.20408/jti.2021.0014
- 3,244 View
- 80 Download
- 1 Citations
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Abstract
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Purpose Traumatic sternal fractures are rare but quite disabling injuries. Timely fixation of sternal fractures reduces pain and prevents respiratory complications. However, the fixation technique should be simple, effective, and readily available in local circumstances.
Methods From January 2014 to March 2020, seven patients with sternal fracture/ dislocation underwent steel wire fixation with the new “Timala” technique. In this technique, adjacent ribs are anchored with two steel wires to form an “X” in front of the fractured segment of the sternum. Patients were followed up clinically and radiologically.
Results Six of the patients were men and one was a female. Five of them had injuries due to falls and two were injured in road traffic accidents. Their age ranged from 18 years to 76 years, with a median age of 41 years. All seven patients experienced immediate recovery from pain and showed evidence of fracture healing on postoperative chest X-rays and clinical examinations.
Conclusions Anchoring ribs to fix the sternum with steel wire is a safe, effective, easily available, and reproducible method to fix sternal fractures or dislocations.
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Summary
Citations
Citations to this article as recorded by
- Features of management of patients with fractures of the sternum
Aslan Alekseevich Teuvov, Arthur Mukharbievich Baziev, Zarema Nuriyidinovna Lovpache , Inna Salodinovna Abazova, Alina Aslanovna Teuvova
Hirurg (Surgeon).2022; (2): 40. CrossRef
Case Report- Development of a Chest Wall Deformity after Conservative Treatment for a Sternal Fracture
- Do Wan Kim, In Seok Jeong, Kook Joo Na, Sang Yun Song, Kyo Seon Lee, Seung Ku Kang
- J Trauma Inj. 2016;29(4):184-186. Published online December 31, 2016
- DOI: https://doi.org/10.20408/jti.2016.29.4.184
- 1,892 View
- 10 Download
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