Fractura esternal: descripción de tratamiento quirúrgico / Sternal fracture: surgical management description

Resumen Objetivo: Describir características demográficas y tratamiento quirúrgico realizado a pacientes con fractura de esternón (FE) en los últimos 5 años. Materiales y Método: Estudio descriptivo retrospectivo de pacientes operados por fractura esternal entre enero de 2015 y enero de 2020. Se analizaron edad, sexo, antecedentes mórbidos, hemodinamia de ingreso, mecanismo causal, características de lesión esternal, lesiones asociadas, indicación quirúrgica y complicaciones. Resultados: Durante el período ingresaron a nuestro hospital 9 pacientes (7 hombres) de 21 a 91 años. Todos fueron operados. La mayoría ingresó con hemodinamia estable. El mecanismo fue siempre traumático. Las indicaciones quirúrgicas fueron: dolor intratable, alteración de la mecánica ventilatoria, tórax volante, deformidad y ayuda en la rehabilitación de un trauma raquimedular. Discusión: La FE es una patología infrecuente, siendo aún más escasa su resolución quirúrgica reportada a nivel mundial. Conclusiones: Presentamos el primer reporte de una serie de casos de FE operada en Chile. La osteosíntesis esternal permite el manejo de la FE con buenos resultados funcionales con baja tasa de morbilidad. Los resultados obtenidos son comparables a los observados en la literatura internacional.

Aim: To describe demographic characteristics and surgical treatment carried out on patients with a sternal fracture (SF) in the last 5 years. Materials and Method: Retrospective descriptive study of patients operated on for SF between January 2015 and January 2020. We analyzed age, sex, morbid history, hemodynamics on admission, causal mechanism and characteristics of sternal injury, associated injuries, surgical indication and complications. Results: During the period, 9 patients were admitted to our hospital (7 men) from 21 to 91 years old. All were operated. Most were admitted with stable hemodynamics. The mechanism was always traumatic. The surgical indications were: intractable pain, alteration of ventilatory mechanics, flail chest, deformity and aid in the rehabilitation of spinal cord trauma. Discussion: SF is an infrequent pathology, its surgical resolution reported worldwide being even scarce. Conclusions: We present the first report of a series of cases of SF operated in Chile. Sternal osteosynthesis allows the management of EF with good functional results with a low morbidity rate. The results obtained are comparable to those observed in the international literature.

Retrosternal Deformations after Coronary Artery Bypass Surgery Using Statistical Shape Analysis

Abstract Introduction: In this study, we aimed to evaluate the anatomical deformations of the major vascular structures in the retrosternal area caused by adhesions following coronary artery bypass grafting (CABG). Methods: This single-center, retrospective study included a total of 40 patients with a previous CABG who were admitted to our emergency unit for any reason and underwent a contrast-enhanced chest computed tomography (patient group) and 40 patients without previous cardiac surgery (control group) between January 2018 and November 2019. The retrosternal area was compared between the groups using the statistical shape analysis method. The distance between the sternum and the ascending aorta and pulmonary artery was measured and anatomical deformations of the retrosternal area were examined. Results: There was a statistically significant difference in the anatomical structures of the retrosternal area between the patient and control groups (P<0.001). The distance from the midsternal line to the highest point of the pulmonary artery was statistically significantly shorter in the patient group, compared to the control group (P=0.013). The distance from the sternum to the ascending aorta was also shorter in the patient group, although it did not reach statistical significance (P>0.05). Conclusions: Our study results showed narrowing of the retrosternal area following CABG and a shorter distance from the sternum to the pulmonary artery than the ascending aorta. Based on these findings, surgeons should be cautious about possible injuries in patients requiring cardiac surgery with repeated median sternotomy.

Histiocitosis de células de Langerhans con compromiso esternal aislado: Caso clínico / Langerhans cell histiocytosis with isolated sternum involvement: A clinical case

La histiocitosis de células de Langerhans es una entidad poco frecuente, que se caracteriza por la proliferación clonal de células dendríticas con amplia variabilidad clínica. En algunos casos, la enfermedad tiene afectación multisistémica con compromiso de vida y, en otros casos, de compromiso exclusivamente óseo, en los que la sobrevida es del 100%. Se presenta a una niña de 8 años que consultó al Servicio de Urgencias por dolor esternal de 4 días de evolución. Mediante estudios de imágenes, se observó una imagen lítica en el esternón. Se decidió la internación para el manejo del dolor y estudio. Se realizó una punción-aspiración con aguja fina, cuya inmunohistoquímica fue positiva para el marcador CD1a, que confirmó el diagnóstico de histiocitosis. La paciente recibió 40 mg/día de metilprednisolona, con buena evolución. Se decide exponer este caso por ser una forma de presentación atípica de una enfermedad poco prevalente, pero cuyo motivo de consulta amerita la sospecha diagnóstica.

The Langerhans Cell Histiocytosis (LCH) is a rare condition, characterized by the proliferation of dendritic cells. Its clinical presentation is variable and ranges from an isolated skin or bone disease, mainly the skull, to a life-threatening multisystemic disease. This case is about a healthy 8-year-old girl with a history of four days of severe sternum pain and no other symptomatology. At the initial evaluation at the emergency department a chest X-ray (Figure 1) and thoracic computed tomography scan with 3-D reconstruction were performed and they showed the sternal osteolytic lesion (Figure 2). She was admitted to the hospital for further evaluation. The immunohistochemistry evaluation of the fine needle aspiration sample was positive for CD1a, confirming the diagnosis of histiocytosis. The patient received methylprednisolone 40 mg/day with clinical improvement.

Sternal nonunion on bone scintigraphy: a case report

Sternal non-union is a severe complication of sternotomy closure following open heart surgeries. Healing problems typically occur in 0.3% to 5% of patients. Technetium-99m methylene diphosphonate [[99m]Tc-MDP] bone scintigraphy has been used to assess bone nonunion to predict the healing response for proper management. In this report, we present the case of a marked sternal nonunion following coronary artery bypass graft [CABG], using radionuclide bone scintigraphy

Estimation of age in the living municipal employees in the age group of 25-45 years by physical and radiological examination.

Employees from government and local self-government bodies come to Departments of Forensic Medicine for age estimation for the purpose of permanent employment. According to the rules and regulations of the Municipal Corporation of Greater Mumbai (MCGM) and court orders, they are confirmed as permanent employees after a specified duration of temporary service. The age criterion is very important as regards their dates of retirement and service benefits. But because of low socioeconomic status & illiteracy, most of these employees have no documentary evidence of their birth dates. Their age, therefore, remains a mystery to be solved. The human body develops very fast in the first 20 years of life, but growth slows thereafter. There is precious little information on the estimation of age in the later years, resulting in the lack of reliable methods for this purpose. A sincere attempt to arrive at a fairly conclusive range of age with respect to changes in physical features, especially graying of hair, wrinkling of skin and radiological evaluations of fusion of components of the sternum and changes in the teeth and mandible with respect to mandibular canal seen in an oral orthopantomogram was contemplated.

The analysis of variation of Han female adolescent bone development in Henan and Zhejiang province / 法医学杂志

OBJECTIVE@#To study the difference of Han female adolescent bone development in Henan and Zhejiang province.@*METHODS@#All radiography including sternal end of clavicle and six main bone joints were taken from 599 female adolescents with age between 12 to 19 in Henan and Zhejiang province. Twenty four skeletal development indexes were analyzed based on "The Grading Standards" of skeletal growth of teenagers and then the bone age were calculated using mathematical model functions. The ratios of the bone age and the chronological age were analyzed by statistical software.@*RESULTS@#The development of Henan female adolescents' skeleton was about 0.39 years earlier than that in Zhejiang at the age of 14-15 years old. The development of Henan female adolescents' skeleton was about 0.37 years later than that in Zhejiang at the age of 15-16 years old. The development of Henan female adolescents' skeleton was about 0.38 years later than that in Zhejiang at the age of 18-19 years old. There was no statistics significance in other age group.@*CONCLUSION@#The female adolescent bone development in Henan province is faster at earlier stage and then slower than that in Zhejiang province. The results provide potential value for the forensic medicine, anthropology and clinical medicine.

A case of sternal insufficiency fracture

We report a case of insufficiency fracture of the sternum in a 70-year-old female patient with a review of the literature. She complained of sudden onset chest pain and aggravating dyspnea. She has been managed with corticosteroid due to chronic obstructive pulmonary disease for 15 years. Diagnosis of sternal insufficiency fracture presented with thoracic kyphosis was made on the basis of absence of trauma history, radiologic findings of lateral chest radiograph, bone scintigraphy and chest computed tomography. Thoracic kyphosis and osteoporosis secondary to menopause, corticosteroid therapy and limited mobility due to chronic obstructive pulmonary disease were considered as predisposing factors of the sternal insufficiency fracture in this patient.

Position of heart in relation to sternum and nipple line at various ages.

Frontal X-ray pictures of 210 healthy children from birth to twelve years of age with radio-opaque markers at sternal ends and both nipples were reviewed. The position of centre of cardiac silhouette was correlated with sternal areas and internipple line. The heart was found to descend with age, its centre lying beneath mid-sternum during first six months of life and beneath lower sternum after infancy (p less than 0.001). The position did not vary with age in relation to internipple line (p greater than 0.05). In 77.6% of all children, it was below the internipple line and in 22.4% above or at the internipple line. Because of the erratic relationship of cardiac centre with internipple line, the latter should not be considered a landmark for cardiac position. External cardiac massage should be applied in relation to sternum and at different locations according to the age. Sites for optimal compression have been suggested. No sexual dimorphism was observed.