Epidemiology and outcomes of traumatic sternal fractures and associated blunt cardiac injury: a nationwide cohort study in the Netherlands

Abstract

Purpose: Comprehensive data on epidemiology, trauma mechanisms, associated injuries, and outcomes of traumatic sternal fractures are scarce. This study analysed nationwide data to improve diagnosis and management within the Dutch healthcare system. Methods: This nationwide retrospective cohort study using the Dutch National Trauma Registry included adult patients admitted with traumatic sternal fractures between 2015 and 2023. Patients with prehospital cardiopulmonary resuscitation or penetrating trauma were excluded. Incidence, patient characteristics, trauma mechanisms, associated injuries, and in-hospital outcomes were analysed. Subgroup analyses evaluated patients with concomitant blunt cardiac injury (BCI). Results: Of 568,399 adult trauma admissions, 4,765 patients (0.84%) sustained traumatic sternal fractures. Median age was 62 years; 60% were male. Motor vehicle accidents (48%) and falls (28%) were the leading mechanisms. 35% were severely injured (ISS ≥ 16). Associated injuries included rib fractures (51%), spinal fractures (36%), and lung contusions (18%). Critical care unit admission was 40%, with median mechanical ventilation duration of 4 days; median hospital stay was 5 days. In-hospital mortality was 5.7%, and 30-day mortality 6.0%. BCI occurred in 9.5% of patients and was associated with a higher number of injuries and increased injury severity, emergency interventions, and critical care admission, but not higher mortality. Conclusion: Traumatic sternal fractures are uncommon, but the incidence in The Netherlands is gradually rising. Sternal fractures frequently occur with severe multisystem injuries. Patients with BCI showed greater injury severity and resource needs. Future research should focus on criteria and clinical significance of BCI, and sternal fracture-specific outcomes and treatment strategies in large patient cohorts.