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Introduction The upper thoracic spine differs from other regions of the spine for extra stability given by the complex rib sternum. Isolated fractures of the sternum are considered harmless. The association between sternum and spine fracture was first described by Fowler and more recently by Park. This association may increase the instability of the spinal injury. The objectives of this presentation are as follows: (1) analyze the kinematics causing this association; (2) describe the impact of the injury; (3) and evaluate the treatment performed. Patients and Methods Four cases are analyzed, quantifying displacement, and angulation of the sternum, and the characteristics of the spinal injury and deformity. Results Most of vertebral lesions were classified as type A, the most affected region was T5 and T10. Three patients with neurological symptoms ASIA E. The majority of the sternum injuries were caused by direct trauma. Conclusion The association of sternum and spine fracture was seen in patients who had suffered high-energy trauma during a car accident. We found no relationship between the angulation of the sternum and its translation to the degree of kyphosis in the thoracic spine. It is important to do good radiographic studies involving the sternum to suspect this relationship.