Current treatment and outcomes of traumatic sternovertebral fractures: a systematic review
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REVIEW ARTICLE
Current treatment and outcomes of traumatic sternovertebral fractures: a systematic review Dorine S. Klei1 · F. Cumhur Öner2 · Luke P. H. Leenen1 · Karlijn J. P. van Wessem1 Received: 18 March 2020 / Accepted: 15 September 2020 © The Author(s) 2020
Abstract Purpose Combined sternal and spinal fractures are rare traumatic injuries with significant risk of spinal and thoracic wall instability. Controversy remains with regard to treatment strategies and the biomechanical need for sternal fixation to achieve spinal healing. The present study aimed to assess outcomes of sternovertebral fracture treatment. Methods A systematic review of literature on the treatment of traumatic sternovertebral fractures was conducted. Original studies published after 1990, reporting sternal and spinal healing or stability were included. Studies not reporting treatment outcomes were excluded. Results Six studies were included in this review, with a total study population of 98 patients: 2 case series, 3 case reports, and 1 retrospective cohort study. 10 per cent of sternal fractures showed displacement. Most spinal fractures were located in the thoracic spine and were AOSpine type A (51%), type B (35%), or type C (14%). 14 per cent of sternal fractures and 49% of spinal fractures were surgically treated. Sternal treatment failure occurred in 5% of patients and biomechanical spinal failure in 8%. There were no differences in treatment failure between conservative and operative treatment. Conclusion Literature on traumatic sternovertebral fracture treatment is sparse. Findings indicate that in most patients, sternal fixation is not required to achieve sternal and spinal stability. However, results of the current review should be cautiously interpreted, since most included studies were of poor quality. Keywords Traumatic sternal and spinal fractures · Sternovertebral fractures · Treatment · Outcomes · Systematic review
Background Combined sternal and spinal fractures, also known as ‘sternovertebral’ fractures, are rare injuries with an estimated incidence of 0.64% in traffic victims [1] and 1% in trauma patients admitted to a level-1 trauma centre [2]. These injuries are primarily caused by a combination of direct impact and indirect flexion-compression or flexion-rotation forces, due to high deceleration in motor vehicle accidents [1, 3–7]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00068-020-01505-y) contains supplementary material, which is available to authorized users. * Dorine S. Klei [email protected] 1
Department of Trauma Surgery, Medical Centre Utrecht, University, Suite G04.232, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
Orthopaedic Surgery, Department of Orthopaedic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
2
In literature, the thoracic spine is regarded as the preferential location for sternovertebral fractures [1, 4, 7–12]. However, concomitant cervical or lumbar spinal fractures with an incidence si
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