Pediatric thoracic cage fractures - mind the sternum: A retrospective analysis of the ACS-TQIP database

Anthony di Natale; Allison L Mak; Rosa Hwang; Myron Allukian 3rd; Gary W Nace Jr; Michael L Nance

doi:10.1097/TA.0000000000004260

Pediatric thoracic cage fractures - mind the sternum: A retrospective analysis of the ACS-TQIP database

J Trauma Acute Care Surg. 2024 Jan 26. doi: 10.1097/TA.0000000000004260. Online ahead of print.

Authors

Anthony di Natale¹, Allison L Mak, Rosa Hwang, Myron Allukian 3rd, Gary W Nace Jr, Michael L Nance

Affiliation

¹ Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, United States.

PMID: 38273439
DOI: 10.1097/TA.0000000000004260

Abstract

Background: The thoracic cage is an anatomical entity formed by the thoracic spine, ribs, and sternum. As part of this osteoligamentous complex, the sternum contributes substantially to the stability of the thoracic spine. This study investigates the influence of a concomitant sternal fracture (SF) on the treatment and hospital course of pediatric patients with a thoracic vertebral fracture (TVF).

Methods: The Trauma Quality Improvement Program (TQIP) datasets from 2016-2020 were reviewed. Patients aged 0-19 with TVF with or without SF following blunt trauma were identified using the abbreviated injury scale (AIS) codes and selected for further data collection. Patients with transverse or spinous process fractures or incomplete data were excluded. Data collected included demographics, mechanisms of injury, clinical variables, procedures, intensive care unit (ICU) admission and length of stay (LOS), total LOS and in-hospital mortality. Continuous variables were analyzed with Wilcoxon Rank Sum test, categorical variables with Chi-squared test.

Results: A total of 13,434 patients were identified, of which 10,292 had isolated TVF (TVF), 788 TVF and concomitant SF (TVF + SF), 2,225 isolated SF (excluded), and 126 incomplete data (excluded). Motor vehicle collisions were the most common mechanism of injury in both groups (TVF: 75%, TVF + SF: 88%), followed by falls (TVF: 23%, TVF + SF: 12%). Spinal cord injuries were more common among TVF + SF patients (6.4% vs 4%). Median injury severity score (17 vs. 12), age (17 vs. 15 years), LOS (5 vs. 3 days), and mortality (5.6% vs. 2.3%) were significantly higher and the need for operative treatment (69% vs. 56%) and ICU admission (53% vs 36%) significantly more frequent in patients with TVF + SF.

Conclusions: Concomitant SF occur in 7% of all pediatric patients with TVF and are associated with increased morbidity and mortality. This combination of injuries is likely the result of greater energy transmission and injury potential.

Level of evidence: Level IV, Therapeutic/ Care management.