Polish Journal of Thoracic and Cardiovascular Surgery
eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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1/2026
vol. 23
 
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Review paper

Operative management of unstable sternal fracture in polytrauma: a case report and literature review

Chrysa Andrikopoulou
1
,
Edvin Selmani
2
,
Vasileios Leivaditis
3
,
Panagiotis Antzoulas
4
,
Konstantinos Tasios
5
,
Elias Liolis
6
,
Andreas Antzoulas
7
,
Dimitrios Litsas
8
,
Panagiotis Dimitrios Papadopoulos
9
,
George Theofanis
7
,
Konstantinos Nikolakopoulos
10
,
Ioannis Panagiotopoulos
11
,
Dimitrios Schizas
12
,
Efstratios Koletsis
13
,
Sofoklis Mitsos
14
,
Periklis Tomos
14
,
Agron Dogjani
2
,
Francesk Mulita
1, 7

  1. Department of General Surgery, General Hospital of Eastern Achaia – Unit of Aigio, Aigio, Greece
  2. Department of Surgery, University of Medicine of Tirana, Albania
  3. Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Kaiserslautern, Germany
  4. Department of Orthopedics, General University Hospital of Patras, Greece
  5. John Radcliffe Hospital Emergency Department, University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK
  6. Department of Oncology, General University Hospital of Patras, Greece
  7. Department of Surgery, General University Hospital of Patras, Greece
  8. Department of Surgery, General Hospital of Lamia, Greece
  9. Department of Surgery, Spital Herisau, Appenzell Ausserrhoden, Switzerland
  10. Department of Vascular Surgery, General University Hospital of Patras, Greece
  11. Division of Cardiac Surgery, Hippokration General Hospital of Athens, Greece
  12. First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Greece
  13. Department of Thoracic Surgery, Attikon General Hospital, National and Kapodistrian University of Athens, Greece
  14. Department of Cardiothoracic Surgery, General University Hospital of Patras, Greece
Kardiochirurgia i Torakochirurgia Polska 2026; 23 (1): 56–63
Online publish date: 2026/04/04
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1. Knobloch K, Wagner S, Haasper C, Probst C, Krettek C, Otte D, Richter M. Sternal fractures occur most often in old cars to seat-belted drivers without any airbag often with concomitant spinal injuries: clinical findings and technical collision variables among 42,055 crash victims. Ann Thorac Surg 2006; 82: 444-50.
2. Recinos G, Inaba K, Dubose J, Barmparas G, Teixeira PG, Talving P, Plurad D, Green D, Demetriades D. Epidemiology of sternal fractures. Am Surg 2009; 75: 401-404.
3. Porter RS, Zhao N. Patterns of injury in belted and unbelted individuals presenting to a trauma center after motor vehicle crash: seat belt syndrome revisited. Ann Emerg Med 1998; 32: 418-424.
4. Athanassiadi K, Gerazounis M, Moustardas M, Metaxas E. Sternal fractures: retrospective analysis of 100 cases. World J Surg 2002; 26: 1243-1246.
5. Celik B, Sahin E, Nadir A, Kaptanoglu M. Sternum fractures and effects of associated injuries. Thorac Cardiovasc Surg 2009; 57: 468-471.
6. Guska S, Pilav I, Musanovic S. Clinical significance of isolated sternal fracture. Med Arh 2010; 64: 17-21.
7. Wang Z, Cai Y, Tong Y, Li H, Zhou H, Ou T, Ye T, Zhang J, Cai K, Chen Z. Global, regional, and national burden of fracture of sternum and/or fracture of one or more ribs: a systematic analysis of incidence, YLDs with projections to 2030. Front Public Health 2025; 13: 1565478.
8. Armstrong BA, Lorch SM, Diaz JJ. Sternal fracture management. Curr Probl Surg 2025; 64: 101725.
9. Odell DD, Peleg K, Givon A, Radomislensky I, Makey I, Decamp MM, Whyte R, Gangadharan SP, Berger RL; Israeli Trauma Group. Sternal fracture: isolated lesion versus polytrauma from associated extrasternal injuries--analysis of 1,867 cases. J Trauma Acute Care Surg 2013; 75: 448-452.
10. Doyle JE, Diaz-Gutierrez I. Traumatic sternal fractures: a narrative review. Mediastinum 2021; 5: 34.
11. Bentley TP, Ponnarasu S, Journey JD. Sternal Fractures. 2024 Jun 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 29939567.
12. LaRoque MC, Obermeier MC, Cole PA. Three-dimensional mapping of sternum fractures from high-energy trauma. J Trauma Acute Care Surg 2022; 93: 750-756.
13. Biswas S, Adileh M, Almogy G, Bala M. Abdominal injury patterns in patients with seatbelt signs requiring laparotomy. J Emerg Trauma Shock 2014; 7: 295-300.
14. Lee DG. Biomechanics of the thorax – research evidence and clinical expertise. J Man Manip Ther 2015; 23: 128-138.
15. Groh J, Kern F, Schenderlein A, Krause J, Perl M, Schulz-Drost S. Traumatic fractures of the sternum – typical distribution and need for subgroups within AO and OTA classification system? Eur J Trauma Emerg Surg 2025; 51: 234.
16. Huecker MR, Stretanski MF. Seat Belt Injury. 2025 May 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 29262033.
17. Fowler AW. Flexion-compression injury of the sternum. J Bone Joint Surg Br 1957; 39-B: 487-497.
18. Schulz-Drost S, Krinner S, Oppel P, Grupp S, Schulz-Drost M, Hennig FF, Langenbach A. Fractures of the manubrium sterni: treatment options and a possible classification of different types of fractures. J Thorac Dis 2018; 10: 1394-1405.
19. Li S, Sun D, Wang C, Hu P, Jin F, Huang W. Fracture mapping in high-energy chest trauma. J Clin Med 2024; 13: 6127.
20. Berg EE. The sternal-rib complex. A possible fourth column in thoracic spine fractures. Spine 1993; 18: 1916-1919.
21. Watkins R 4th, Watkins R 3rd, Williams L, Ahlbrand S, Garcia R, Karamanian A, Sharp L, Vo C, Hedman T. Stability provided by the sternum and rib cage in the thoracic spine. Spine 2005; 30: 1283-1286.
22. Dogrul BN, Kiliccalan I, Asci ES, Peker SC. Blunt trauma related chest wall and pulmonary injuries: an overview. Chin J Traumatol 2020; 23: 125-138.
23. Polytrauma Guideline Update Group. Level 3 guideline on the treatment of patients with severe/multiple injuries: AWMF Register-Nr. 012/019. Eur J Trauma Emerg Surg 2018; 44 (Suppl 1): 3-271.
24. Hochhegger B, Altmayer S. Traumatic sternal fractures. Radiol Bras 2022; 55: IX.
25. Perez MR, Rodriguez RM, Baumann BM, Langdorf MI, Anglin D, Bradley RN, Medak AJ, Mower WR, Hendey GW, Nishijima DK, Raja AS. Sternal fracture in the age of pan-scan. Injury 2015; 46: 1324-1327.
26. Heidelberg L, Uhlich R, Bosarge P, Kerby J, Hu P. The depth of sternal fracture displacement is not associated with blunt cardiac injury. J Surg Res 2019; 235: 322-328.
27. Klei DS, Schutte H, Öner FC, van Baal MC, Leenen LP, van Wessem KJ. Traumatic sternal fractures can be safely treated conservatively – a 13-year retrospective cohort study. J Surg Res 2021; 4: 572-587.
28. Chowdhury N, Serena G, Velcu L, Barrett L, Angus LDG. An unusual case of sternal osteomyelitis and purulent mediastinitis after a traumatic sternal body fracture. Cureus 2024; 16: e74011.
29. McKim LH. A method of fixation for fractures of thesternum. Ann Surg 1943; 118: 158-160.
30. Harston A, Roberts C. Fixation of sternal fractures: a systematic review. J Trauma 2011; 71: 1875-1879.
31. Schulz-Drost S, Oppel P, Grupp S, Schmitt S, Carbon RT, Mauerer A, Hennig FF, Buder T. Surgical fixation of sternal fractures: preoperative planning and a safe surgical technique using locked titanium plates and depth limited drilling. J Vis Exp 2015; 95: e52124.
32. Hulse J, Eriksson E. A novel approach to sternal fracture repair with the implementation of a compression/distraction device. Cureus 2023; 15: e33218.
33. Chou SS, Sena MJ, Wong MS. Use of SternaLock plating system in acute treatment of unstable traumatic sternal fractures. Ann Thorac Surg 2011; 91: 597-599.
34. Queitsch C, Kienast B, Voigt C, Gille J, Jürgens C, Schulz AP. Treatment of posttraumatic sternal non-union with a locked sternum-osteosynthesis plate (TiFix). Injury 2011; 42: 44-46.
35. Al-Qudah A. Operative treatment of sternal fractures. Asian Cardiovasc Thorac Ann 2006; 14: 399-401.
36. Majercik S, Pieracci FM. Chest wall trauma. Thorac Surg Clin 2017; 27: 113-121.
37. Ahmad K, Katballe N, Pilegaard H. Fixation of sternal fracture using absorbable plating system, three years follow-up. J Thorac Dis 2015; 7: E131-E134.
38. Tam DY, Nedadur R, Yu M, Yanagawa B, Fremes SE, Friedrich JO. Rigid plate fixation versus wire cerclage for sternotomy after cardiac surgery: a meta-analysis. Ann Thorac Surg 2018; 106: 298-304.
39. Xu S, Zhu J, Yu Q, Peng L, Tao Y, Qi S, Han H, Liu Y. Surgical treatment of sternum comminuted fracture with memory alloy embracing fixator. J Thorac Dis 2021; 13: 2194-2202.
40. Lafci G, Yasar E, Cicek OF, Irdem A, Uzun A, Yalcinkaya A. A novel modified Robicsek technique for sternal closure: “double-check”. Asian Cardiovasc Thorac Ann 2014; 22: 758-760.
41. Allen KB, Icke KJ, Thourani VH, Naka Y, Grubb KJ, Grehan J, Patel N, Guy TS, Landolfo K, Gerdisch M, Bonnell M. Sternotomy closure using rigid plate fixation: a paradigm shift from wire cerclage. Ann Cardiothorac Surg 2018; 7: 611-620.
42. Zhao Y, Yang Y, Gao Z, Wu W, He W, Zhao T. Treatment of traumatic sternal fractures with titanium plate internal fixation: a retrospective study. J Cardiothorac Surg 2017; 12: 22.
43. Xie ZX, Zhou XT, Zhang DS, Yang Y, Zhang GL, Chen MH, Liang Z. Minimally invasive plate osteosynthesis for the treatment of sternal fracture in the lower chest: a case report. J Int Med Res 2019; 47: 4033-4038.
44. Ricalde P, Caccamese J, Norby C, Posnick JC, Hartman MJ, von Fraunhofer JA. Strength analysis of 6 resorbable implant systems: does heating affect the stress-strain curve? J Oral Maxillofac Surg 2008; 66: 2493-2497.
45. Racine S, Émond M, Audette-Côté JS, Le Sage N, Guimont C, Moore L, Chauny JM, Bergeron É, Vanier L. Delayed complications and functional outcome of isolated sternal fracture after emergency department discharge: a prospective, multicentre cohort study. Canad J Emerg Med 2016; 18: 349-357.
46. Lee H, Mohindra R, Milne K, Bond C. SGEM Hot Off the Press: Delayed complications of sternal fractures. Canad J Emerg Med 2017; 19: 392-397.
47. Voss B, Bauernschmitt R, Will A, Krane M, Kröss R, Brockmann G, Libera P, Lange R. Sternal reconstruction with titanium plates in complicated sternal dehiscence. Eur J Cardiothorac Surg 2008; 34: 139-145.
48. Loop FD, Lytle BW, Cosgrove DM, Mahfood S, McHenry MC, Goormastic M, Stewart RW, Golding LA, Taylor PC. J. Maxwell Chamberlain memorial paper. Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity, and cost of care. Ann Thorac Surg 1990; 49: 179-186.
49. Marasco S, Lee G, Summerhayes R, Fitzgerald M, Bailey M. Quality of life after major trauma with multiple rib fractures. Injury 2015; 46: 61-65.
50. Velmahos GC, Vassiliu P, Chan LS, Murray JA, Berne TV, Demetriades D. Influence of flail chest on outcome among patients with severe thoracic cage trauma. Int Surg 2002; 87: 240-244.
Copyright: © 2026 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska). This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
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