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Sternal fixation for isolated traumatic sternal fractures improves pain and upper extremity range of motion

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Introduction

Sternal fractures are debilitating due to intractable pain, constant fracture movement and limited range of motion (ROM) of the upper extremities (UE). Traditional treatment comprises mainly of pain control, delaying return to daily activities. Recently, sternal fixation has gained popularity. There is, however, a lack of literature demonstrating efficacy. We report our experience of traumatically fractured sternal fixation.

Methods

Following IRB approval, a retrospective chart review was completed for all patients undergoing sternal fixation by a single trauma surgeon at our Level I trauma center. Basic demographics were obtained. Primary outcomes included average cumulative pain scores, total cumulative narcotic amounts and total number of pain medication agents utilized prior to and after sternal fixation. Secondary outcome included physical therapy UE ROM before and after surgery. Paired t tests were used for comparison; significance set at p < 0.05.

Results

Thirteen patients underwent sternal fixation from 8/2016 to 2/2018. Average age was 54.4 ± 20.8 years; 54% were female. All patients experienced blunt trauma; average injury severity score was 15.8 ± 10.9 and abbreviated chest injury score was 2.5 ± 0.51. Average intensive care unit/hospital length of stay was 2.3/10.2 days. Average pain scores significantly improved by a score of 3.5 postoperatively (preoperative = 7.08 ± 2.3, postoperative = 3.54 ± 2.5; p = 0.001). Total pain medications required by sternal fixation patients significantly decreased by 1 medication postoperatively (preoperative = 4.2 medications, postoperative = 3.2 medications; p = 0.002). Average narcotic requirements significantly decreased by 7.59 morphine milligram milliequivalents (MME) after sternal fixation (preoperative amount = 71.78 MME, postoperative amount = 64.19 MME; p = 0.041). Every patient had limited UE ROM preoperatively; however, all but one patient resumed full UE ROM postoperatively (p < 0.001). There were no postoperative complications.

Conclusions

Sternal fixation is a safe and effective procedure resulting in improved pain, decreased narcotic requirements, and faster recovery.

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Authors and Affiliations

  1. Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE, 68198-3280, USA

    Zachary M. Bauman, Ujwal Yanala, Brett H. Waibel, Gautam K. Malhotra, Samuel Cemaj, Charity H. Evans & Lisa L. Schlitzkus

Authors
  1. Zachary M. Bauman
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  2. Ujwal Yanala
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  3. Brett H. Waibel
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  4. Gautam K. Malhotra
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  5. Samuel Cemaj
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  6. Charity H. Evans
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  7. Lisa L. Schlitzkus
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Contributions

All authors contributed substantially to this research project. All authors were fully involved in this research project and collectively designed, conducted and interpreted the data. Furthermore, all authors reviewed and approved the decision to submit this manuscript for publication in its current form. The institution providing the patient population and data collected was the University of Nebraska Medical Center, Omaha, NE.

Corresponding author

Correspondence to Zachary M. Bauman.

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Conflict of interest

There are no conflicts of interest or financial interests to disclose for any of the contributing authors.

Ethical approval

Dr. Zachary Bauman is an educational consultant for Zimmer-Biomet and KLS-Martin. This study was approved by the appropriate ethics committee at our institution and all ethical standards were followed.

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Bauman, Z.M., Yanala, U., Waibel, B.H. et al. Sternal fixation for isolated traumatic sternal fractures improves pain and upper extremity range of motion. Eur J Trauma Emerg Surg 48, 225–230 (2022). https://doi.org/10.1007/s00068-020-01568-x

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  • DOI: https://doi.org/10.1007/s00068-020-01568-x

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