title: Sternal fractures occur most often in old cars to seat-belted drivers without any airbag often with concomitant spinal injuries: clinical findings and technical collision variables among 42,055 crash victims.
abstract: BACKGROUND
  The incidence and treatment of sternal fractures caused by traffic accidents is of increasing importance to ensure best possible outcomes.
  
  
  METHODS
  Analysis of technical indicators of the collision, preclinical, and clinical data of patients with sternal fractures from 1985 to 2004 among 42,055 injured patients was assessed by an Accident Research Unit. Two time groups were categorized: 1985 to 1994 (group A) versus 1995 to 2004 (group B).
  
  
  RESULTS
  Of 42,055 patients, 267 (0.64%) suffered a sternal fracture. Regarding the vehicle type, the majority occurred after car accidents in 0.81% (251 of 31,183 patients), followed by 0.19% (5 of 2,633 patients) driving motorbike, and 0.11% (4 of 3,258 patients) driving a truck. Ninety-one percent wore a safety belt. Only 13% of all passengers suffering a sternal fracture had an airbag on board (33 of 255 car/trucks), with an airbag malfunction in 18%. The steering column was deformed in 39%, the steering wheel in 36%. Cars in the recent years were significantly older (group B, 7.67 +/- 5 years, versus group A, 5.88 +/- 5 years; p = 0.003). Cervical spine injuries are frequent (23% versus 22%), followed by multiple rib fractures (14% versus 12%) and lung contusions (12% versus 11%). We found 9 of 146 (6%) and 3 of 121 patients (3%) with heart contusion among the 267 sternal fractures. Maximal abbreviated injury scale score was 2.56 +/- 1.3 versus 2.62 +/- 1.3 (group A versus B, p = 0.349). Eighteen percent of patients were polytraumatized, with 11.2% dying at the scene, 2.3% in the hospital.
  
  
  CONCLUSIONS
  Sternal fractures occur most often in old cars to seat-belted drivers often without any airbag. Severe multiple rib fractures and lung contusion are concomitant injuries in more than 10% each, indicating the severity of the crash. Over a 20-year period, the injury severity encountered was not different, with 18% polytrauma patients suffering sternal fractures.
authors.affiliation: Trauma Department, Medical School Hannover, Hannover, Germany. kknobi@yahoo.com
authors.forename: Karsten
authors.initials: K
authors.lastname: Knobloch
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wagner
authors.forename: Carl
authors.initials: C
authors.lastname: Haasper
authors.forename: Christian
authors.initials: C
authors.lastname: Probst
authors.forename: Christian
authors.initials: C
authors.lastname: Krettek
authors.forename: Dietmar
authors.initials: D
authors.lastname: Otte
authors.forename: Martinus
authors.initials: M
authors.lastname: Richter
mesh_terms: D000063:Accidents, Traffic; D017278:Air Bags; D001794:Blood Pressure; D050723:Fractures, Bone / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D015600:Glasgow Coma Scale; D006339:Heart Rate; D006801:Humans; D007902:Length of Stay; D009104:Multiple Trauma / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D012622:Seat Belts; D013124:Spinal Injuries / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D013249:Sternum / Q000293:injuries*