Surgical management of traumatic isolated sternal fracture and manubriosternal dislocation

Abstract

The aim of this study was to evaluate the surgical procedures of osteosynthesis and the respective costs in isolated sternal fractures and manubriosternal dislocations. Between January 2006 and July 2011, we treated 47 patients with an isolated fracture and 18 patients with a dislocation of the sternum surgically. In case of sternal fracture, the titanium plate was used in 30 (64%), steel plate in 12 (25%), and steel wire in 5 patients (11%). The stabilization after traumatic luxation was obtained with steel wire in 4 patients (22%) and titanium plate associated with demineralized bone matrix in 14 patients (78%). The quality adjusted life years (QALYs) was analyzed, as well as the incremental cost-effectiveness ratio based on QALYs. In the sternal fractures, titanium plate showed a decreased time of intervention (30 [2] minutes), length of stay (3 [1] days), and total cost (&OV0556;2,277.10) compared with steel plate (&OV0556;2,667.70) and steel wire (&OV0556;2,801.60) procedures, displaying an excellent difference in QALYs (0.825 and 1.615, respectively). In the sternal dislocation, steel wire technique highlighted a poor QALYs, although this approach was less expensive than titanium plate with demineralized bone matrix (&OV0556;3,553.60 vs. &OV0556;6,047.80). Incremental cost-effectiveness ratio revealed that the titanium plate costs were &OV0556;623.55 more than the steel wire per QALYs gained. The rigid titanium plate application ensured a safe and easy management of traumatic sternal lesions with a good prognosis of patients, justified by the improved QALYs compared with other methods. Therapeutic study, level IV; economic analysis, level IV.