title: Fractures of the upper transthoracic cage.
abstract: We have reviewed our experience in managing 11 patients who sustained an indirect sternal fracture in combination with an upper thoracic spinal injury between 2003 and 2006. These fractures have previously been described as 'associated' fractures, but since the upper thorax is an anatomical entity composed of the upper thoracic spine, ribs and sternum joined together, we feel that the term 'fractures of the upper transthoracic cage' is a better description. These injuries are a challenge because they are unusual and easily overlooked. They require a systematic clinical and radiological examination to identify both lesions. This high-energy trauma gives severe devastating concomitant injuries and CT with contrast and reconstruction is essential after resuscitation to confirm the presence of all the lesions. The injury level occurs principally at T4-T5 and at the manubriosternal joint. These unstable fractures need early posterior stabilisation and fusion or, if treated conservatively, a very close follow-up.
authors.affiliation: Service de Chirurgie, Orthopédique CHT, New Caledonia, Melanesia. jl.labbe@cht.nc
authors.forename: J-L
authors.initials: JL
authors.lastname: Labbe
authors.forename: O
authors.initials: O
authors.lastname: Peres
authors.forename: O
authors.initials: O
authors.lastname: Leclair
authors.forename: R
authors.initials: R
authors.lastname: Goulon
authors.forename: P
authors.initials: P
authors.lastname: Scemama
authors.forename: F
authors.initials: F
authors.lastname: Jourdel
mesh_terms: D000328:Adult; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods / Q000592:standards*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D009460:Neurologic Examination; D010264:Paraplegia / Q000209:etiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology; D011859:Radiography; D012253:Rib Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods; D013249:Sternum / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult