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      Fractura de esternón, fijación con lámina y tornillos. Revisión de la literatura a propósito de un caso Translated title: Fracture of sternum, fixation with blade and screws. Review of the literature on a case

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          Abstract

          RESUMEN Introducción: las fracturas aisladas de esternón son infrecuentes, representando el 8 % de los ingresos por trauma torácico, existiendo pocos reportes en la literatura médica. El tratamiento generalmente consiste en realizar reposo, tomar medicamentos para aliviar el dolor y el fomento de ejercicios de respiración profunda para evitar el colapso localizado de los pulmones. En fracturas esternales más graves, tales como aquellas con desplazamiento óseo, pueden requerir intervención quirúrgica para restaurar la alineación ósea y fijar los huesos, usando alambres, clavos o placas con tornillos. Objetivo: demostrar la eficacia de la osteosíntesis con lámina y tornillos en la fractura esternal con desplazamiento óseo. Método: se presenta un caso donde se describe el diagnóstico y tratamiento de un paciente que sufrió una precipitación de alrededor 5 metros y recibió un trauma directo en la cara anterior del tórax, con el diagnóstico de fractura aislada de esternón con gran desplazamiento óseo e intenso dolor torácico. Resultados: se llevó a cabo un tratamiento quirúrgico para restaurar la alineación ósea y fijar los huesos mediante el uso de lámina y tornillos, la evolución fue satisfactoria y en los diez meses posteriores el paciente se mantuvo sin síntomas y se retiró la lámina. Conclusiones: esta modalidad de reducción y osteosíntesis es un proceder rápido y eficaz, sin dejar secuelas o algún grado de incapacidad relacionados a la ruptura.

          Translated abstract

          ABSTRACT Introduction: isolated fractures of the sternum are infrequent, representing 8% of the income from chest trauma, and there are few reports in the medical literature. The treatment usually consists of resting, taking medications to relieve pain and encouraging deep breathing exercises to avoid localized collapse of the lungs. In more severe sternal fractures, such as those with bone displacement, they may require surgical intervention to restore bone alignment and fix the bones, using wires, nails or plates with screws. Objective: to demonstrate the efficacy of osteosynthesis with lamina and screws in the sternal fracture with bone displacement. Method: We present a case through a work where we describe the diagnosis and treatment of a patient who suffered a rainfall of around 5 meters and received a direct trauma to the anterior aspect of the thorax, with the diagnosis of isolated fracture of the sternum with large bone displacement. Intense chest pain Results: we carried out a surgical treatment to restore the bone alignment and fix the bones by using foil and screws, the evolution was satisfactory and in the ten months after the patient remained without symptoms and we removed the lamina. Conclusions: this modality of reduction and osteosynthesis is a fast and effective procedure, without leaving sequels or some degree of disability related to the rupture.

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          Most cited references20

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          Sternal fractures: retrospective analysis of 100 cases.

          Isolated sternal fractures are seen with increasing frequency in road accidents, especially since the introduction of seatbelt legislation. The medical records of all our patients who were treated with a diagnosis of sternal fracture (SF) over the past two decades were retrospectively reviewed to determine the incidence, morbidity, and mortality of this entity. Between 1984 and 1998, 100 consecutive patients were admitted to the Department of Surge Surgery, General Hospital of Nikea-Piraeus, Greece, for SF. There were 72 men and 28 women ranging in age between 17 and 84 years. Sixty-seven patients sustained an isolated SF and the remaining 33 had a SF in combination with multiple injuries such as flail chest (n = 19), head injury (n = 18), limb fractures (n = 10), spinal fractures (n = 4), hear contusion (n = 1), hemo-pneumothorax (n = 9), pneumothorax (n = 6), hemomediastinum (n = 5), and pericarditis (n = 2), among others. All patients with a radiological diagnosis were admitted for cardiac monitoring for at least 24 hours. Electrocardiogram (ECG), determinations of cardiac enzyme levels such as lactic dehydrogenase, creatine kinase, and creatine kinase-MB, and evaluation by a cardiologist were routinely performed. An echocardiogram was performed as indicated by the cardiologist. Seven patients underwent operation, two for abdominal bleeding, two for chest wall and sternal stabilization, two for open pneumothorax, and one for massive hemothorax. Eight of our patients needed ventilatory support. Four of them died from respiratory insufficiency, myocardial infarction, and heart and lung contusion. Although an isolated SF carries a good prognosis, careful evaluation and clinical observation are essential.
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            Current treatment and outcomes of traumatic sternal fractures—a systematic review

            Purpose Traumatic sternal fractures are rare injuries. The most common mechanism of injury is direct blunt trauma to the anterior chest wall. Most (> 95%) sternal fractures are treated conservatively. Surgical fixation is indicated in case of fracture instability, displacement or non-union. However, limited research has been performed on treatment outcomes. This study aimed to provide an overview of the current treatment practices and outcomes of traumatic sternal fractures and dislocations. Methods A systematic review of literature published from 1990 to June 2017 was conducted. Original studies on traumatic sternal fractures, reporting sternal healing or sternal stability were included. Studies on non-traumatic sternal fractures or not reporting sternal healing outcomes, as well as case reports (n = 1), were excluded. Results Sixteen studies were included in this review, which reported treatment outcomes for 191 patients. Most included studies were case series of poor quality. All patients showed sternal healing and 98% reported pain relief. Treatment complications occurred in 2% of patients. Conclusions Treatment of traumatic sternal fractures and dislocations is an underexposed topic. Although all patients in this review displayed sternal healing, results should be interpreted with caution since most included studies were of poor quality.
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              Fixation of sternal fractures: a systematic review.

              Traumatic sternal fractures occur in approximately 3% to 8% of all blunt trauma patients. Most of these fractures are treated conservatively, but a small number require operative intervention. Only a few studies have reported operative fixation of sternal fractures, and no investigation to our knowledge has systematically reviewed the literature on this intervention. We conducted a systematic review of the literature published from 1990 through September 2010 regarding the treatment of traumatic sternal fractures. We analyzed the available evidence regarding the surgical fixation of these fractures, the type of fixation used, the timing of the surgery, complications, and patient outcomes. Twelve articles with 76 cases of surgically repaired sternal fractures met our study criteria. The indications for surgery, timing, and methods used for fixation were diverse. For instance, plates were used in 52 patients and wiring was selected in 24 patients for fixation. General and cardiothoracic surgeons treated the majority of sternal fractures requiring operative fixation. No serious postoperative complications were found in our review. Although the outcomes were generally positive, only one-half of the articles documented patient follow-up. In future studies, focus needs to be placed on long-term results and specific indications for surgery. The first step toward a standardized sternal fracture operative trial must be a prospective study of incidence and nonoperative long-term outcomes. It is likely that as the interest and demand for plate fixation increases, the demand for orthopedic involvement with sternal fractures will also increase.
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                Author and article information

                Journal
                rcur
                Revista Cubana de Reumatología
                Rev Cuba Reumatol
                Editorial CIMEQ (La Habana, , Cuba )
                1817-5996
                2019
                : 21
                : suppl 1
                : e70
                Affiliations
                [1] La Habana La Habana orgnameUniversidad de Ciencias Médicas de La Habana orgdiv1Hospital Miguel Enríquez orgdiv2Facultad de Ciencias Médicas Miguel Enríquez Cuba
                Article
                S1817-59962019000400009 S1817-5996(19)02100000009
                c3f063ba-cf90-40ad-b0e6-439e35c58250

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 06 January 2019
                : 01 April 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 21, Pages: 0
                Product

                SciELO Cuba

                Categories
                Estudios de casos

                fijación con lámina y tornillos,fractura de esternón,fixing with sheet and screws,sternum fracture

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