title: Sternal fractures are frequent among polytraumatised patients following high deceleration velocities in a severe vehicle crash.
abstract: BACKGROUND
  Sternal fractures are a rare entity. We hypothesised that a sternal fracture is an indicator of injury severity following traffic accidents.
  
  
  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 assessed by an Accident Research Unit.
  
  
  RESULTS
  Only 267/42,055 patients (0.64%) suffered a sternal fracture within the 20-year period. Soft tissue bruises are most often concomitant injuries (55%), followed by cervical spine injuries (23%), multiple rib fractures (14%) and lung injuries (12%). Eighteen percent of patients were polytraumatised, with 11.2% dying at the scene, 2.3% in hospital. Deceleration velocity (DeltaV) was significantly correlated with injury severity score (ISS, r2=0.92, y=0.408x-4.1573) as with maximal abbreviated injury scale (MAIS, r2=0.81). Patients suffering a sternal fracture being polytraumatised had significantly higher deceleration velocity (60+/-17km/h versus 37+/-16km/h [37.3+/-10.6mph versus 23+/-9.9mph], p=0.0001). Patients dying with a sternal fracture had a significant higher deceleration velocity (61km/h, 37.9mph) versus those surviving (38km/h, 23.6mph, p=0.0001). Regarding the vehicle type, the majority occurred after car accidents in 0.81% (251/31,183 patients), followed by 0.19% (5/2633 patients) driving motorbikes, and 0.11% (4/3258 patients) driving a truck. Only 13% of all passengers suffering a sternal fracture had an airbag on board (33/255 car/trucks), with an airbag malfunction in 18%. 22% were not admitted to hospital, 28% were admitted to a trauma ICU with a sternal fracture.
  
  
  CONCLUSIONS
  In 1/5 of cases sternal fractures encountered in polytraumatised patients following significantly higher deceleration velocities during the crash. Typically car drivers without a functioning airbag suffer a sternal fracture.
authors.affiliation: Trauma Department, Medical School Hannover, Germany. kknobi@yahoo.com
authors.forename: K
authors.initials: K
authors.lastname: Knobloch
authors.forename: S
authors.initials: S
authors.lastname: Wagner
authors.forename: C
authors.initials: C
authors.lastname: Haasper
authors.forename: C
authors.initials: C
authors.lastname: Probst
authors.forename: C
authors.initials: C
authors.lastname: Krettek
authors.forename: P M
authors.initials: PM
authors.lastname: Vogt
authors.forename: D
authors.initials: D
authors.lastname: Otte
authors.forename: M
authors.initials: M
authors.lastname: Richter
mesh_terms: D015998:Abbreviated Injury Scale; D000063:Accidents, Traffic; D017278:Air Bags; D003654:Deceleration / Q000009:adverse effects*; D004638:Emergency Treatment / Q000379:methods; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D015600:Glasgow Coma Scale; D006801:Humans; D007902:Length of Stay / Q000191:economics; D009104:Multiple Trauma / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies; D013249:Sternum / Q000293:injuries*; D016896:Treatment Outcome