Nonunion after sternal fractures: outcomes after surgical management

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Background: Sternal fractures are common findings in trauma patient with chest wall being implicated in 15% of trauma and up to 55% of polytrauma patients.Historically, non-displaced fractures without secondary injuries have been treated conservatively, which may increase the risk of sternal nonunion development.This causes pain and can significantly reduce quality of life.The long-term outcome of patients who received surgical treatment of sternal nonunion has not been reported up until now.The aim of this study was to analyze the outcomes of a cohort of patients after surgical treatment of sternal nonunion.Methods: Monocentric electronic chart review from patients who have been submitted to sternal plate fixation.Inclusion criteria were radiologically confirmed and symptomatic sternal nonunion and follow-up of at least 3 months.Sternal plate fixation was performed using two parallel 2.8 mm sternal plates (MatrixRIB, DePuy Synthes ® ).Results: Thirty-two patients underwent sternal osteosynthesis between 2018 and 2021, of which 8 for nonunion.The 8 patients included for analysis had a median age of 54±21.3years.The main cause of trauma was motor vehicle accident.Median time between trauma and surgery was 334 days.Median operative time was 65±34 min and median length of stay (LOS) was 8±13 days.One patient developed wound infection requiring antibiotic therapy and 1 patient developed wound seroma.Conclusions: Sternal fractures are common in trauma patients and often conservatively treated with good outcomes.In some cases, pain symptoms can persist for 6 months or more.Nonunion should be confirmed by computed tomography (CT) scan and surgical therapy taken into consideration.

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