PMID- 34250172
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220424
IS  - 2325-9671 (Print)
IS  - 2325-9671 (Electronic)
IS  - 2325-9671 (Linking)
VI  - 9
IP  - 6
DP  - 2021 Jun
TI  - Management of Vertical Sternal Fracture Nonunion in Elite-Level Athletes.
PG  - 23259671211010804
LID - 10.1177/23259671211010804 [doi]
LID - 23259671211010804
AB  - BACKGROUND: Sternal fractures are rare, and they can be treated nonoperatively. 
      Vertical sternal fractures have rarely been reported. PURPOSE: To describe the 
      management and surgical treatment of a series of elite-level athletes who 
      presented with symptomatic nonunions of a vertical sternal fracture. STUDY 
      DESIGN: Case series; Level of evidence, 4. METHODS: Patients with an established 
      symptomatic nonunion of a vertical sternal fracture, as diagnosed by computed 
      tomography (CT) or magnetic resonance imaging (MRI), underwent open reduction and 
      internal fixation using autologous bone graft and cannulated lag screws. The 
      patients were assessed preoperatively and at the final follow-up using the 
      Rockwood sternoclavicular joint (SCJ) score; Constant score; and shortened 
      version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores. 
      Bony union was confirmed on postoperative CT scan. RESULTS: Five patients (4 men 
      and 1 woman) were included; all were national- or international-level athletes 
      (rugby, judo, show-jumping, and MotoGP). The mean age at surgery was 23.4 years 
      (range, 19-27 years), the mean time from injury to referral was 13.6 months 
      (range, 10-17 months), and the mean time from injury to surgery was 15.8 months 
      (range, 11-20 months). The mean follow-up was 99.4 months (range, 25-168 months). 
      There was a significant improvement after surgery in the mean Rockwood SCJ score 
      (from 12.6 to 14.8 [P < .05]), Constant score (from 84 to 96.4 [P < .05]; 80% met 
      the minimal clinically important difference [MCID] of 10.4 points), and QuickDASH 
      (from 6.8 to 0.98 [P < .05]; 0% met the MCID of 15.9 points). Four of the 
      patients were able to return to sport at their preinjury level, and 1 patient 
      retired for nonmedical reasons. All of the fractures had united on the 
      postoperative CT scan. There were no postoperative complications. CONCLUSION: 
      Vertical fractures of the sternum are very rare and tend to behave clinically 
      like an avulsion fracture injury to the capsuloligamentous structure of the 
      inferior SCJ. The requirement of advanced imaging to diagnose this injury means 
      that the actual incidence and natural history are not known. For high-demand 
      athletes, early identification, surgical reduction, and fixation are likely to 
      achieve the best outcome.
CI  - (c) The Author(s) 2021.
FAU - Bardos, Andrea
AU  - Bardos A
AD  - Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals 
      Trust, Cambridge, UK. RINGGOLD: 89744
FAU - Sabhrawal, Sanjeeve
AU  - Sabhrawal S
AD  - Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals 
      Trust, Cambridge, UK. RINGGOLD: 89744
FAU - Tytherleigh-Strong, Graham
AU  - Tytherleigh-Strong G
AD  - Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals 
      Trust, Cambridge, UK. RINGGOLD: 89744
LA  - eng
PT  - Journal Article
DEP - 20210624
PL  - United States
TA  - Orthop J Sports Med
JT  - Orthopaedic journal of sports medicine
JID - 101620522
PMC - PMC8237216
OTO - NOTNLM
OT  - avulsion fracture
OT  - nonunion
OT  - sternal fracture
OT  - sternoclavicular joint
COIS- The authors declared that there are no conflicts of interest in the authorship 
      and publication of this contribution. AOSSM checks author disclosures against the 
      Open Payments Database (OPD). AOSSM has not conducted an independent 
      investigation on the OPD and disclaims any liability or responsibility relating 
      thereto.
EDAT- 2021/07/13 06:00
MHDA- 2021/07/13 06:01
PMCR- 2021/06/24
CRDT- 2021/07/12 05:58
PHST- 2020/12/20 00:00 [received]
PHST- 2021/02/09 00:00 [accepted]
PHST- 2021/07/12 05:58 [entrez]
PHST- 2021/07/13 06:00 [pubmed]
PHST- 2021/07/13 06:01 [medline]
PHST- 2021/06/24 00:00 [pmc-release]
AID - 10.1177_23259671211010804 [pii]
AID - 10.1177/23259671211010804 [doi]
PST - epublish
SO  - Orthop J Sports Med. 2021 Jun 24;9(6):23259671211010804. doi: 
      10.1177/23259671211010804. eCollection 2021 Jun.