Thorac Cardiovasc Surg 2018; 66(08): 670-677
DOI: 10.1055/s-0037-1607305
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Analysis on the Age Distribution of Sternum Fractures

Sonja Schmitt
1   Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Germany
,
Sebastian Krinner
1   Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Germany
,
Andreas Langenbach
1   Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Germany
,
Friedrich F. Hennig
1   Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Germany
,
Stefan Schulz-Drost
2   Department of Pediatric Surgery, University Hospital Erlangen, Germany
3   Department of Trauma und Orthopedic Surgery, BG Hospital, Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
› Author Affiliations
Further Information

Publication History

27 April 2017

06 September 2017

Publication Date:
27 October 2017 (online)

Abstract

Background Sternum fractures (SFs) are described as a rare entity of bony fractures. Various accident mechanisms may cause SF such as the direct impact of traffic accidents and also by indirect mechanisms within the framework of falls. Osteoporotic fractures also play an increasing role in SF, but no reliable data on the age distribution of SF in a representative collective have been published so far.

Material and Methods The age distribution of all inpatients treated with SF (S22.2) in Germany from 2005 to 2012 using diagnosis-related group-based routine data was evaluated. Various accident statistics are included in the interpretation of age peaks.

Results A total of 47,893 patients (24,960 as main diagnosis and 22,933 as secondary diagnosis) were included in the study. SF is a rarity in childhood, with a share of 1.83% before the age of 16 years, followed by a sudden increase in the frequency up to the age of 20 years. A decrease in the frequency is observed up to the age of 35 years before it increases again to the age of 75 years. Three age peaks can be observed at 18, 55, and 75 years. Those who are older than 65 years account for 43.3% of total SF.

Discussion and Conclusion The first age summit after the age of 16 years shows an identical course to the frequency of traffic accidents of this age group, as well as the decline to the fourth decade and the subsequent resurgence up to the fifth decade. After 65 years, the incidence of accidents increases, in particular, the risk of falling in elderly people. In the context of a weaker bone structure, low falls are a common course for fragility fractures. The present analysis of routines shows for the first time the age distribution of the SF taking into account all hospital cases of the observation period.

 
  • References

  • 1 Knobloch K, Wagner S, Haasper C. , et al. Sternal fractures occur most often in old cars to seat-belted drivers without any airbag often with concomitant spinal injuries: clinical findings and technical collision variables among 42,055 crash victims. Ann Thorac Surg 2006; 82 (02) 444-450
  • 2 Schulz-Drost S, Oppel P, Grupp S. , et al. Bony injuries of the thoracic cage in multiple trauma: incidence, concomitant injuries, course and outcome [in German]. Unfallchirurg 2016; 119 (12) 1023-1030
  • 3 Athanassiadi K, Gerazounis M, Moustardas M, Metaxas E. Sternal fractures: retrospective analysis of 100 cases. World J Surg 2002; 26 (10) 1243-1246
  • 4 Recinos G, Inaba K, Dubose J. , et al. Epidemiology of sternal fractures. Am Surg 2009; 75 (05) 401-404
  • 5 Schulz-Drost S, Krinner S, Langenbach A. , et al; TraumaRegister DGU. Concomitant sternal fracture in flail chest: an analysis of 21,741 polytrauma patients from the TraumaRegister DGU®. Thorac Cardiovasc Surg 2017 Doi: 10.1055/s-0037-1598194. [Epub ahead of print] PMID: 28187475
  • 6 Fowler AW. Flexion-compression injury of the sternum. J Bone Joint Surg Br 1957; 39-B (03) 487-497
  • 7 Helal B. Fracture of the manubrium sterni. J Bone Joint Surg Br 1964; 46: 602-607
  • 8 Schulz-Drost S, Oppel P, Grupp S. , et al. The oblique fracture of the manubrium sterni caused by a seatbelt--a rare injury? Treatment options based on the experiences gained in a level I trauma centre. Int Orthop 2016; 40 (04) 791-798
  • 9 Bailey J, Vanderheiden T, Burlew CC. , et al. Thoracic hyperextension injury with complete “bony disruption” of the thoracic cage: case report of a potentially life-threatening injury. World J Emerg Surg 2012; 7 (01) 14
  • 10 Lin KH, Ponampalam R. Sternum insufficiency fracture presenting as acute chest pain: a case report and review of the literature. Eur J Emerg Med 2006; 13 (02) 122-124
  • 11 Giangregorio LM, Leslie WD. ; Manitoba Bone Density Program. Time since prior fracture is a risk modifier for 10-year osteoporotic fractures. J Bone Miner Res 2010; 25 (06) 1400-1405
  • 12 Llompart-Pou JA, Chico-Fernández M, Sánchez-Casado M. , et al; Trauma Neurointensive Care Working Group of the Spanish Society of Intensive Care Medicine (SEMICYUC). Age-related injury patterns in Spanish trauma ICU patients. Results from the RETRAUCI. Injury 2016; 47 (Suppl. 03) S61-S65
  • 13 Fichtel I, Fernandez FF, Wirth T. Sternal fracture in growing children: a rare and often overlooked fracture? Documentation of four cases [in German]. Unfallchirurg 2016; 119 (07) 570-574
  • 14 Yeh DD, Hwabejire JO, DeMoya MA, Alam HB, King DR, Velmahos GC. Sternal fracture—an analysis of the National Trauma Data Bank. J Surg Res 2014; 186 (01) 39-43
  • 15 Lindner R. BEST (Bone Evaluation Study) – Osteoporose in Deutschland: Prävalenz, Behandlung und Kosten. Website Stand: 06.08.2015 (cited April 26, 2017). Available at: http://www.versorgungsforschung-deutschland.de/showpdf.php
  • 16 Odell DD, Peleg K, Givon A. , et al; Israeli Trauma Group. Sternal fracture: isolated lesion versus polytrauma from associated extrasternal injuries--analysis of 1,867 cases. J Trauma Acute Care Surg 2013; 75 (03) 448-452
  • 17 Schulz-Drost S, Mauerer A, Grupp S, Hennig FF, Blanke M. Surgical fixation of sternal fractures: locked plate fixation by low-profile titanium plates--surgical safety through depth limited drilling. Int Orthop 2014; 38 (01) 133-139
  • 18 Homagk L, Siekmann H, Schmidt I, Schmidt J. The sterno-vertebral instability - a new classification and therapeutic options [in German]. Z Orthop Unfall 2014; 152 (04) 343-350
  • 19 Berg EE. The sternal-rib complex. A possible fourth column in thoracic spine fractures. Spine 1993; 18 (13) 1916-1919
  • 20 Morgenstern M, von Rüden C, Callsen H. , et al. The unstable thoracic cage injury: The concomitant sternal fracture indicates a severe thoracic spine fracture. Injury 2016; 47 (11) 2465-2472
  • 21 Robert Koch Institut. Beiträge zur Gesundheitsberichterstattung des Bundes: Das Unfallgeschehen bei Erwachsenen in Deutschland, Ergebnisse des Unfallmoduls der Befragung “Gesundheit in Deutschland aktuell 2010,” Stand 2013 (cited April 26, 2017). Page 16/17. Available at: http://www.rki.de/DE/Content/Gesundheitsmonitoring/Gesundheitsberichterstattung/GBEDownloadsB/unfallbericht_geda.pdf%3F__blob%3DpublicationFile
  • 22 WHO Global Report on Falls Prevention in older Age. Geneva, Switzerland: World Health Organization; 2007. . Available at http://www.who.int/ageing/publications/Falls_prevention7March.pdf# . Accesses September 2017
  • 23 Wilbacher I. Hauptverband der österreichischen Sozialversicherungsträger. Sturzprävention für ältere Menschen Version 2 2014 (cited April 26, 2017). Available at: http://www.hauptverband.at/cdscontent/load?contentid=10008.615719&version=1425627108
  • 24 Scheidt-Nave C, Fuchs J, Freiberger E, Rapp K. Neues zur Epidemiologie von Stürzen und sturzbedingten Verletzungen in Deutschland (27.11.2012) (cited April 26, 2017). Available at: http://www.aktivinjedemalter.de/html/img/pool/Epidemiologie_HTA_Berlin_X.pdf