title: [The sterno-vertebral instability - a new classification and therapeutic options].
abstract: BACKGROUND
  Sternal fractures in the context of high velocity trauma are commonly referred to as impact injuries. In general, these are considered to be treated conservatively. In the literature, there are only a few studies and a small number of cases. We know that not only high velocity accidents cause combined trauma of sternum and spine, but also low velocity traumas in the elderly are relatively common. How should such combinations of injuries be treated?
  
  
  METHODS
  Based on 11 patients from the years 2005 to 2013 with different combinations of sternal and spinal injuries, we distinguish the therapeutic approach of ventral, dorsal or combined stabilisation, with the help of a four-column classification of these injuries.
  
  
  RESULTS
  We classify sternovertebral injury into 4 types. First the descendant type with an injury from C I to C VII and sternum, second the horizontal type (T I to T XII and sternum), third the ascendant type (L I to L V and sternum) and fourth a dissociative type. The recommended therapy of the descendant type is dorsoventral stabilisation of the spinal column plus stabilisation of the sternum. The horizontal type should be treated with dorsal stabilisation of the spine and stabilisation of the sternum. The ascendant type should be supplied with dorsoventral stabilisation of the spinal column and conservative therapy of the sternum. In case of the dissociative type one should supply each injury independently.
  
  
  CONCLUSIONS
  The literature on sternal injuries and their treatment is low. Combinations of sternum and spine injuries have not yet been processed systematically in literature. Thus, there is no concerted standard of therapeutic options. The very rare occurrence of this injury combination often leads to this injury type being forgotten in the primary evaluation of casualties.
authors.affiliation: Unfallchirurgie, Asklepios Kliniken Weißenfels.
authors.forename: L
authors.initials: L
authors.lastname: Homagk
authors.affiliation: Unfallchirurgie, Universität Halle.
authors.forename: H
authors.initials: H
authors.lastname: Siekmann
authors.affiliation: Clinical Research Support, trauma-and-more, Werneuchen.
authors.forename: I
authors.initials: I
authors.lastname: Schmidt
authors.affiliation: Unfallchirurgie, Asklepios Kliniken Weißenfels.
authors.forename: J
authors.initials: J
authors.lastname: Schmidt
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000368:Aged; D000465:Algorithms; D001860:Bone Plates; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000145:classification* / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007593:Joint Instability / Q000145:classification* / Q000000981:diagnostic imaging / Q000628:therapy*; D007738:Kyphosis / Q000145:classification / Q000000981:diagnostic imaging / Q000628:therapy; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D011542:Pseudarthrosis / Q000145:classification / Q000000981:diagnostic imaging / Q000628:therapy; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000145:classification* / Q000000981:diagnostic imaging / Q000628:therapy*; D013249:Sternum / Q000000981:diagnostic imaging / Q000293:injuries*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers