Sternal fractures in children

Abstract

BACKGROUND: Sternal fractures are a rare nosological form of injuries in children. The injuries of the sternum often are accompanied by fractures of the long bones of the skeleton or thoracic vertebrae. Isolated fractures of the sternum in children are rarely diagnosed. The medical information on pediatric sternum injuries is limited by a small number of scientific publications.

AIM: Our aim is to study the peculiarities of traumagenesis, clinic, diagnostics, treatment of sternal fractures in children.

MATERIALS AND METHODS: Clinical material for the served as experience in providing traumatology assistance to 8 children who received sternal fractures. The average age of the injured children was 11.5 years. 87.5% of the victims were boys. In all patients, sternal fractures had been diagnosed along with other damage to the musculoskeletal system. During the survey, traditional diagnostic methods for emergency traumatology were used.

RESULTS: The leading mechanism of injury, i.e., falling from a height of 2 meters and more were found in 62.5% of victims. In all clinical observations, fractures were localized at the level of the body of the sternum. All the children, besides sternal fractures, had uncomplicated fractures of the vertebral bodies. A total of 30 bodies of the vertebrae were compressed. Most often (in 16.75% of cases), the Th_V vertebra was compressed. The reliable symptoms of sternal fractures in patients were difficult and painful breathing, local swelling of soft tissues, soreness of the sternum during palpation, and amplification of the pain in the fracture area during pressure applied on half of the chest. Compliance with the strict bed mode on the roller-reclinator under the area of the compreated vertebrae and the exclusion of the axial load on the spine was a favorable fact sufficient and led to pain disappearance in 3–7 days. In all cases, the sternum fractures did not require any surgery. Fractures of the bodies of the vertebrae in 7 children were also treated conservatively. The Corsets “Orlett” was used for immobilization, ensuring a reliable degree of fixation. The average hospital stay amounted to 16. The duration of the hospital stay was influenced by the accompanying bone-articular damage to the skeleton. The evaluation of the long-term results was performed in 4 children. The results were interpreted as good.

CONCLUSIONS: When applying for emergency traumatology assistance to children with chest injury and spine, it is necessary to purposefully explore the state of the sternum.

Keywords

children / sternal fractures / features of traumagenesis, clinic, diagnosis, treatment

References

[1] Ozsoy IA, Tezcan MA. A rare injury in children: sternum fractures. J Coll Physicians Surg Pak. 2019;29(10):993–995. DOI: 10.29271/jcpsp.2019.10.993

[2] Ozsoy I.A., Tezcan M.A. A rare injury in children: sternum fractures // J. Coll. Physicians Surg. Pak. 2019. Vol. 29. No. 10. P. 993–995. DOI: 10.29271/jcpsp.2019.10.993

[3] Korneev IA, Axadov TA, Semenova NA, et al. Mul’tispiral’naya komp’yuternaya tomografiya v diagnostike ostroj skeletnoj travmy’ u detej. Detskaya xirurgiya. 2018;22(6):292–295. (In Russ.). DOI: 10.18821/1560-9510-2018-22-6-292-295

[4] Корнеев И.А., Ахадов Т.А., Семенова Н.А. и др. Мультиспиральная компьютерная томография в диагностике острой скелетной травмы у детей // Детская хирургия. 2018. Т. 22. № 6. С. 292–295. DOI: 10.18821/1560-9510-2018-22-6-292-295

[5] Xoxlov VV. Mexanizm travmy’ grudnoj kletki pri frontal’nom stolknovenii legkovogo avtomobilya s rebenkom-peshexodom. Sudebnaya medicina. 2018;4(1):8–10. (In Russ.). DOI: 10.19048/2411-8729-2018-4-1-8-10

[6] Хохлов В.В. Механизм травмы грудной клетки при фронтальном столкновении легкового автомобиля с ребенком-пешеходом // Судебная медицина. 2018. Т. 4. № 1. С. 8–10. DOI: 10.19048/2411-8729-2018-4-1-8-10

[7] Dmitriev RV, Shinkarik IG, Rudakova E.A. Zakry’taya travma grudi u detej. Permskij medicinskij zhurnal. 2011;XXXVIII(6):25–28. (In Russ.)

[8] Дмитриев Р.В., Шинкарик И.Г., Рудакова Э.А. Закрытая травма груди у детей // Пермский медицинский журнал. 2011. Т. XXXVIII. № 6. С. 25–28.

[9] Rosenfeld EH, Lau P, Shah SR, et al. Sternal fractures in children: An analysis of the National Trauma Data Bank. J Pediatr Surg. 2019;54(5):980–983. DOI: 1016/j.jpedsurg.2019.01.031

[10] Rosenfeld E.H., Lau P., Shah S.R., et al. Sternal fractures in children: An analysis of the National Trauma Data Bank // J. Pediatr. Surg. 2019. Vol. 54. No. 5. P. 980–983. DOI: 1016/j.jpedsurg.2019.01.031

[11] Chalphin AV, Mooney DP. Pediatric sterna fractures: A single center retrospective review. J Pediatr Surg. 2020;55(7):1224–1227. DOI: 10.1016/j.jpedsurg.2019.10.002

[12] Chalphin A.V., Mooney D.P. Pediatric sterna fractures: A single center retrospective review // J. Pediatr. Surg. 2020. Vol. 55. No. 7. P. 1224–1227. DOI: 10.1016/j.jpedsurg.2019.10.002

[13] Ramgopal S, Shaffiev SA, Conti KA. Pediatric sterna fractures from a level 1 trauma center. J Pediatr Surg. 2018;54(8):1628–1631. DOI: 10.1016/j.jpedsurg.2018.08.040

[14] Ramgopal S., Shaffiev S.A., Conti K.A. Pediatric sterna fractures from a level 1 trauma center // J. Pediatr. Surg. 2018. Vol. 54. No. 8. P. 1628–1631. DOI: 10.1016/j.jpedsurg.2018.08.040

[15] Sereda AP, Andrianova MA. Rekomendacii po oformleniyu dizajna issledovaniya. Travmatologiya i ortopediya Rossii. 2019;25(3): 165–184. (In Russ.). DOI: 10.21823/2311-2905-2019-25-3-165-184

[16] Середа А.П., Андрианова М.А. Рекомендации по оформлению дизайна исследования // Травматология и ортопедия России. 2019. Т. 25. № 3. С. 165–184. DOI: 10.21823/2311-2905-2019-25-3-165-184

[17] Meinberg EG, Agel J, Roberts CS, et al. Fracture and dislocation classification compendium-2018. J Orthop Trauma. 2018;32:1–10. DOI: BOT0000000000001063

[18] Meinberg E.G., Agel J., Roberts C.S., et al. Fracture and dislocation classification compendium-2018 // J. Orthop. Trauma. 2018. Vol. 32. P. 1–10. DOI: BOT0000000000001063

[19] Baker SP, O’Neill В, Haddon W, et al. The injuriseverity score: a method for describing patients with multiple injuries and evaluting emergency care. Trauma. 1974;14(3):187–196. DOI: 10.1097/00005373-197403000-00001

[20] Baker S.P., O’Neill В., Haddon W., et al. The injuriseverity score: a method for describing patients with multiple injuries and evaluting emergency care // Trauma. 1974. Vol. 14. № 3. P. 187–196. DOI: 10.1097/00005373-197403000-00001

[21] Athanassidi K, Gerazounis M, Moustardis M, et al. Sternal fractures: retrospective analysis of 100 cases. World J Surg. 2002;26(10):1243–1246. DOI: 10.1007/s00268-002-6511-5

[22] Athanassidi K., Gerazounis M., Moustardis M., et al. Sternal fractures: retrospective analysis of 100 cases // World J. Surg. 2002. Vol. 26. No. 10. P. 1243–1246. DOI: 10.1007/s00268-002-6511-5

[23] Gafarov XZ, Tumakaev RF. Lechenie bol’ny’x s perelomami grudopoyasnichnogo otdela pozvonochnika s’emnymi korsetami marki Orlett. Prakticheskaya medicina. 2015;89(4):52–58. (In Russ.)

[24] Гафаров Х.З., Тумакаев Р.Ф. Лечение больных с переломами грудопоясничного отдела позвоночника съемными корсетами марки Orlett // Практическая медицина. 2015. Т. 89. № 4. С. 52–58.

[25] Sesia SB, Heinrich DM, Kocher GJ, et al. Treatment of isolated sterna fracture with a vacuum bell in a 8-year-old boy. Interact Cardiovasc Thorac Surg. 2018;26(5):888–889. DOI: 10.1093/icvts/ivx421

[26] Sesia S.B., Heinrich D.M., Kocher G.J., et al. Treatment of isolated sterna fracture with a vacuum bell in a 8-year-old boy // Interact. Cardiovasc. Thorac. Surg. 2018. Vol. 26. No. 5. P. 888–889. DOI: 10.1093/icvts/ivx421

[27] Schmidt S, Kriner S, Langenbach A, et al. Analysis on the age distribution of sternal fractures. Thorac Cardiovasc Surg. 2018;66(8):670–677. DOI: 10.1055/s-0037-1607305

[28] Schmidt S., Kriner S., Langenbach A., et al. Analysis on the age distribution of sternal fractures // Thorac. Cardiovasc. Surg. 2018. Vol. 66. No. 8. P. 670–677. DOI: 10.1055/s-0037-1607305

[29] Buhlmann M, Castiqlioni A, Flores O, et al. Clinical and radiological study of sterna fractures in pediatrics. Radiologia. 2019;61(3):234–238. DOI: 10.1016/j.rx.2019.01.004

[30] Buhlmann M., Castiqlioni A., Flores O., et al. Clinical and radiological study of sterna fractures in pediatrics // Radiologia. 2019. Vol. 61. No. 3. P. 234–238. DOI: 10.1016/j.rx.2019.01.004

[31] Skryabin EG, Aksel’rov MA, Zotov PB, et al. Suicident sredi pacientov travmatologicheskogo centra. Suicidologiya. 2020;11(2): 101–117. (In Russ.). DOI: 10.32878/suiciderus.20-11-02(39)-101-117

[32] Скрябин Е.Г., Аксельров М.А., Зотов П.Б., и др. Суицидент среди пациентов травматологического центра // Суицидология. 2020. Т. 11. № 2. С. 101–117. DOI: 10.32878/suiciderus.20-11-02(39)-101-117

[33] Weaver AA, Schoell SL, Nguen CM, et al. Morphometric analysis of variation in the sternum with sex and age. J Morphol. 2014;275(11):1284–1299. DOI: 10.1002/jmor.20302

[34] Weaver A.A., Schoell S.L., Nguen C.M., et al. Morphometric analysis of variation in the sternum with sex and age // J. Morphol. 2014. Vol. 275. No. 11. P. 1284–1299. DOI: 10.1002/jmor.20302

[35] Wang H, Feng C, Liu H, et al. Epidemiologic features of traumatic fractures in children and adolescents: A 9-year retrospective study. Biomed Res Int. 2019;2019:8019063. DOI: 10.1155/2019/8019063

[36] Wang H., Feng C., Liu H., et al. Epidemiologic features of traumatic fractures in children and adolescents: A 9-Year retrospective study // Biomed. Res. Int. 2019. Vol. 2019. P. 8019063. DOI: 10.1155/2019/8019063

[37] Krinner S, Schmitt S, Grupp S, et al. Haufigkeit and Altersverteilung kombinierter Verletzungen der sterno-supratebralen Wirbelsaule: Analyse von Routinedaten aus deutschen Krankenhausern 2005–2012. Unfallchirurg. 2018;121(8):642–648. DOI: 10.1007/s00113-018-0460-4

[38] Krinner S., Schmitt S., Grupp S., et al. Haufigkeit and Altersverteilung kombinierter Verletzungen der sterno-supratebralen Wirbelsaule: Analyse von Routinedaten aus deutschen Krankenhausern 2005-2012 // Unfallchirurg. 2018. Vol. 121. No. 8. P. 642–648. DOI: 10.1007/s00113-018-0460-4

[39] Scheyerer MJ, Zimmermann SM, Bouaicha S, et al. Location of sterna fractures as a possible marker for associated injuries. Emerg Med Int. 2013;2013:407589. DOI: 10.1155/2013/407589

[40] Scheyerer M.J., Zimmermann S.M., Bouaicha S., et al. Location of sterna fractures as a possible marker for associated injuries // Emerg. Med. Int. 2013. Vol. 2013. P. 407589. DOI: 10.1155/2013/407589

[41] Huang Z, Chen F, Huang J, et al. Treatment of middle-super thoracic fractures associated with the sternum fracture. Int J Clin Exp Med. 2015;8(6):9751–9757.

[42] Huang Z., Chen F., Huang J., et al. Treatment of middle-super thoracic fractures associated with the sternum fracture // Int. J. Clin. Exp. Med. 2015. Vol. 8. No. 6. P. 9751–9757.

[43] Ovetunji TA, Jackson H, Obirieze A, et al. Associated injuries in traumatic sternal fractures: a review of the national trauma data bank. Am Surg. 2013;79(7):702–705. DOI: 10.1177//000313481307900714

[44] Ovetunji T.A., Jackson H., Obirieze A., et al. Associated injuries in traumatic sternal fractures: A review of the national trauma data bank // Am. Surg. 2013. Vol. 79. No. 7. P. 702–705. DOI: 10.1177//000313481307900714

[45] Hechter S, Huyer D, Mancon D. Sternal fractures as a manifestation of abusive injury in children. Pediatr Radiol. 2002;32(12):902–906. DOI: 10.1007/s00247-002-0807-3

[46] Hechter S., Huyer D., Mancon D. Sternal fractures as a manifestation of abusive injury in children // Pediatr. Radiol. 2002. Vol. 32. No. 12. P. 902–906. DOI: 10.1007/s00247-002-0807-3

[47] Kim EY, Yang HJ, Sung YM, et al. Sternal fracture in the emergency department: diagnostic value of multidetector CT with sagittal and coronal reconstruction images. Eur J Radiol. 2012;81(5):708–711. DOI: j.ejrad.2011.05.029

[48] Kim E.Y., Yang H.J., Sung Y.M., et al. Sternal fracture in the emergency department: diagnostic value of multidetector CT with sagittal and coronal reconstruction images // Eur. J. Radiol. 2012. Vol. 81. No. 5. P. 708–711. DOI: j.ejrad.2011.05.029

[49] Ferquson LP, Wilkinson AG, Beattie TF. Fracture of the sternum in children. Emerg Med J. 2003;20(6):518–529. DOI: 10.1136/emj.20.6.518

[50] Ferquson L.P., Wilkinson A.G., Beattie T.F. Fracture of the sternum in children // Emerg. Med. J. 2003. Vol. 20. No. 6. P. 518–529. DOI: 10.1136/emj.20.6.518

[51] Sesia SB, Prufer F. Mayr J. Sternal fracture in children: diagnosis by ultrasonoqraphy. European J Pediatr Surg Rep. 2017;5(1):39–42. DOI: 10.1055/s-0037-1606107

[52] Sesia S.B., Prufer F., Mayr J. Sternal fracture in children: Diagnosis by ultrasonoqraphy // European. J. Pediatr. Surg. Rep. 2017. Vol. 5. No. 1. P. 39–42. DOI: 10.1055/s-0037-1606107

[53] Fukuhara S, Sameschima T, Matsuo H, et al. Sternal fracture complicated by a subcutaneous abscess in a 5-year-old boy and diagnosed using point-of-care ultrasound. J Emerg Med. 2019;56(5):536–539. DOI: 10.1016/j.jemermed.2018.12.040

[54] Fukuhara S., Sameschima T., Matsuo H., et al. Sternal fracture complicated by a subcutaneous abscess in a 5-year-old boy and diagnosed using point-of-care ultrasound // J. Emerg. Med. 2019. Vol. 56. No. 5. P. 536–539. DOI: 10.1016/j.jemermed.2018.12.040

[55] Pavlov IV, Vissarionov SV, Gusev MG, et al. Primenenie ortezov tulovishha pri konservativnom lechenii detej s kompressionnymi perelomami pozvonkov grudnoj i poyasnichnoj lokalizacii (obzor literatury). Travmatologiya i ortopediya Rossii. 2014;72(2):125–129. (In Russ.)

[56] Павлов И.В., Виссарионов С.В., Гусев М.Г., и др. Применение ортезов туловища при консервативном лечении детей с компрессионными переломами позвонков грудной и поясничной локализации (обзор литературы) // Травматология и ортопедия России. 2014. Т. 72. № 2. С. 125–129.

[57] Korovessis P, Sdouqos G, Dimas T. Spontaneous fracture of the sternum in a child being treated in a Boston brace for kyphoscoliosis. A case report and review of the literature. Eur Spine J. 1994;3(2):112–124. DOI: 10.1007/BF02221450

[58] Korovessis P., Sdouqos G., Dimas T. Spontaneous fracture of the sternum in a child being treated in a Boston brace for kyphoscoliosis. A case report and review of the literature // Eur. Spine J. 1994. Vol. 3. No. 2. P. 112–124. DOI: 10.1007/BF02221450

[59] Safranek J. Sternal fractures and their surgical treatment. Acta Chir Orthop Traumatol Cech. 2015;82(1):76–79.

[60] Safranek J. Sternal fractures and their surgical treatment // Acta Chir. Orthop. Traumatol. Cech. 2015. Vol. 82. No. 1. P. 76–79.

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Skryabin E.G., Naumov S.V., Zotov P.B., Akselrov M.A.