Abstract
Introduction: Fractures of the sternum result from a direct blow or from an indirect mechanism with hyperflexion of the spine. The association between spinal injury and sternal fractures has been reported but is commonly overlooked and underestimated.
Aims: Our aim was to study the clinical and radiological effects of an attendant sternal fracture on vertebral fractures. Berg first described the extra stability afforded to the thoracic spine by the sternal-rib complex and the adverse effects of damage to this “4th column” apropos of 2 cases.
Materials and Methods: None patients were admitted to our unit from October 1996 to August 2001 suffering from vertebral fractures and concomitant sternal fractures. The clinical notes and plain film radiographs of these patients were studied.
Results: The average age of the 9 patients (5 males and 4 females) was 33 years (range 21–73). Seven had been involved in road traffic accidents and 2 had fallen from a height. Four patients had injuries to their cervical spine, 4 to their thoracic spine and one had a lumbar spine fracture. In terms of neurological compromise, only one of the cervical groups had a neurological deficit compared to all 4 in the thoracic group (2 complete and 2 incomplete). The patient with the lumbar spine fracture suffered incomplete neurological compromise. All 6 of the patients with neurological compromise underwent surgical management. The other 3 patients were treated conservatively.
Conclusion: It has been traditionally accepted that the sternum is injured only in association with upper thoracic spine. Our findings suggest that spinal injury at lower thoracic, upper lumbar or cervical level may also be associated with sternal injuries. However, the relative severity of the vertebral injury and neurological compromise in the thoracic spine subgroup offers clear support of Berg’s “4th column” theory of thoracic spine fractures when compared to fractures of the cervical or lumbar spine with sternal injuries.
The abstracts were prepared by Raymond Moran. Correspondence should be addressed to him at the Irish Orthopaedic Assocation, c/o Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland.
