Misunderstood cardiac involvement with heart impairment in traumatic sternal fracture: an enzyme-guided evaluation.
BACKGROUND
Isolated sternal fractures occur more and more frequently in traffic road accidents in particular after the introduction of the seat-belt law. This study sets out to assess by laboratory parameters the incidence and consequences of pericardial and myocardial involvement in sternal injury.


METHODS
Between June 1997 and March 2007, 50 consecutive patients were admitted to our Thoracic Surgical Unit with acute traumatic sternal fractures. X-ray, CT scan, standard 12-lead electrocardiogram (ECG) and echocardiographic evaluation were obtained in all patients. (28 males, 22 females), with displaced and undisplaced fractures. The patients were hospitalised for cardiorespiratory monitoring, pain control and physiotherapy. Oxygen implementation was performed to obtain an arterial saturation above 96%. Supplementary investigations or therapeutic interventions were assessed if clinically indicated.


RESULTS
Our data, according to literature, show that sternal trauma must be careful evaluated by monitoring of vital parameters. In our collection we have no mortality with complex comorbidity. The interparametric relation between laboratory values and cardiac involvement was not significant anyway . The prolonged CK-MB peak level in a large number of patients is related with cardiac impairment.


CONCLUSIONS
Our results suggest that in traumatic sternal fractures enzymatic activity of CK-MB, echocardiographic investigation and careful monitoring for the first 96 hours are necessary. The cardiac compliance is inadequate in polytrauma patients and can lead to cardiac impairment.
Università degli Studi di Messina, A.O.U. Policlinico "G. Martino", Cattedra e U.O.C. di Chirurgia Toracica, Italy.
M
M
Monaco
B
B
Mondello
F
F
Monaco
I
I
Vasta
O
O
Perrone
V
V
Micali
M
M
Barone
D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic; D001019:Aortic Rupture / Q000209:etiology / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood*; D004562:Electrocardiography; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D050723:Fractures, Bone / Q000150:complications* / Q000175:diagnosis / Q000201:enzymology* / Q000601:surgery; D006335:Heart Injuries / Q000175:diagnosis / Q000201:enzymology* / Q000209:etiology* / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000209:etiology; D012189:Retrospective Studies; D013249:Sternum / Q000293:injuries*; D016896:Treatment Outcome
D015415:Biomarkers; D052279:Creatine Kinase, MB Form