Risk factors of blunt cardiac injury and routine use of echocardiography in sternum fractures

Abstract

The incidence of cardiac injury related with sternal fracture ranges from 18.0% to 62.0%. Our aim in the study is to reveal the risk factors of blunt cardiac injury in patients with sternum fractures and to determine the necessity of routine use of echocardiography in diagnosis. 64 patients with sternum fracture due to blunt trauma between 2010 and 2018 were examined. Patients were retrospectively evaluated for age, gender, cause of trauma, fracture localization (manubrium or corpus), fracture type (displacement or nondeplase), treatment methods, complications, electrocardiography (ECG) and echocardiography findings (ECO), cardiac enzyme (Creatine kinase myocardial band (CK- MB) and Troponin I) levels, length of intensive care and hospital stay. The cause of the sternum fracture was the in-vehicle traffic accident in 39 (60%) patients, and 31 (79.4%) of these patients were wearing seat belts. Twenty-two (34.3%) of the patients were non-vehicle traffic accidents and three (4.6%) were falling from height. When the fracture localization was examined, 49 (76.5%) of the patients had fractures in the corpus and 15 (23.4%) of the manubrium. 29 of the sternal fractures were displaced (45.3%). Acute ECG change was detected in 15 (23.4%) of the patients. Cardiac enzyme height was determined in 11 (17.1%) patients. ECG and cardiac enzyme results were evaluated together and ECO was performed in 17 (26.5%) patients for differential diagnosis of cardiac pathology. Minimal pericardial effusion was detected in 4 (6.2%) of the patients, while myocardial contusion or vascular pathology was not observed. A significant relation was found between the displacement of the sternum fracture and age, high cardiac enzyme values and abnormal ECO findings. However, there was no significant relationship between gender, acute abnormal ECG findings, length of intensive care and hospital stay. Although the rate of serious cardiac injury is low in sternum fractures, ECG and cardiac enzyme examination should be performed in all patients due to high morbidity and mortality. Additional ECO examination should be performed in advanced age patients and displaced corpus stern fractures.