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This case report presents the diagnostic difficulties encountered by a 96-year-old woman with osteoporosis who experienced acute chest pain following minor trauma, eventually diagnosed with a sternal fracture. It highlights the nuanced presentation and diagnostic challenges associated with sternal fractures in older patients. Despite the prevalent use of chest radiography and computed tomography in acute trauma assessments, this case emphasizes their limitations, as both modalities initially failed to detect the sternal fracture. The successful identification of the fracture using ultrasound (US) underscores the utility of this modality in detecting subtle yet clinically significant injuries. This report advocates for a high index of suspicion for sternal fractures in older patients presenting with chest pain after minor trauma and suggests that US is a valuable, less invasive diagnostic tool. By illuminating the potential for minor trauma to cause major injury and the critical role of US in diagnosis, this case provides valuable insights into the management of sternal fractures in the geriatric population, urging clinicians to consider atypical presentations in diagnostic evaluations.
RESUMEN
BACKGROUND: The evidence for the treatment of midthoracic fractures in elderly patients is weak. The aim of this study was to evaluate midterm results after posterior stabilization of unstable midthoracic fractures in the elderly. METHODS: Retrospectively, all patients aged ≥65 suffering from an acute unstable midthoracic fracture treated with posterior stabilization were included. Trauma mechanism, ASA score, concomitant injuries, ODI score and radiographic loss of reduction were evaluated. Posterior stabilization strategy was divided into short-segmental stabilization and long-segmental stabilization. RESULTS: Fifty-nine patients (76.9 ± 6.3 years; 51% female) were included. The fracture was caused by a low-energy trauma mechanism in 22 patients (35.6%). Twenty-one patients died during the follow-up period (35.6%). Remaining patients (n = 38) were followed up after a mean of 60 months. Patients who died were significantly older (p = 0.01) and had significantly higher ASA scores (p = 0.02). Adjacent thoracic cage fractures had no effect on mortality or outcome scores. A total of 12 sequential vertebral fractures occurred (35.3%). The mean ODI at the latest follow up was 31.3 ± 24.7, the mean regional sagittal loss of reduction was 5.1° (± 4.0). Patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral fractures during follow-up (p = 0.03). CONCLUSION: Unstable fractures of the midthoracic spine are associated with high rates of thoracic cage injuries. The mortality rate was rather high. The majority of the survivors had minimal to moderate disabilities. Thereby, patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral body fractures during follow-up.
Asunto(s)
Fracturas de la Columna Vertebral , Anciano , Femenino , Fijación Interna de Fracturas , Humanos , Vértebras Lumbares/lesiones , Masculino , Estudios Retrospectivos , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/cirugía , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/lesiones , Vértebras Torácicas/cirugía , Resultado del TratamientoRESUMEN
INTRODUCTION: The thoracic cage is an anatomical entity composed of the upper thoracic spine, the ribs and the sternum. The aims of this study were primarily to analyse the combined injury pattern of thoracic cage injuries and secondarily to evaluate associated injuries, trauma mechanism, and clinical outcome. We hypothesized that the sternal fracture is frequently associated with an unstable fracture of the thoracic spine and that it may be an indicator for unstable thoracic cage injuries. PATIENTS AND METHODS: Inclusion criteria for the study were (a) sternal fracture and concomitant thoracic spine fracture, (b) ISS≥16, (c) age under 50 years, (d) presence of a whole body computed-tomography performed at admission of the patient to the hospital. Inclusion criteria for the control group were as follows: (a) thoracic spine fracture without concomitant sternal fracture, (b)-(d) same as study cohort. RESULTS: In a 10-year-period, 64 patients treated with a thoracic cage injury met inclusion criteria. 122 patients were included into the control cohort. In patients with a concomitant sternal fracture, a highly unstable fracture (AO/OTA type B or C) of the thoracic spine was detected in 62.5% and therefore, it was significantly more frequent compared to the control group (36.1%). If in patients with a thoracic cage injury sternal fracture and T1-T12 fracture were located in the same segment, a rotationally unstable type C fracture was observed more frequently. The displacement of the sternal fracture did not influence the severity of the concomitant T1-T12 fracture. CONCLUSIONS: The concomitant sternal fracture is an indicator for an unstable burst fracture, type B or C fracture of the thoracic spine, which requires surgical stabilization. If sternal and thoracic spine fractures are located in the same segment, a highly rotationally unstable type C fracture has to be expected.