Sternal fracture: Difference between revisions

Latest revision as of 13:12, 10 April 2021

Background

Anatomy of the sternum.

Fracture is more likely in restrained passengers than unrestrained passengers (high-energy trauma)
Isolated sternal fracture is relatively benign
- Low mortality (<1%)
- Low intrathoracic morbidity
Sternal body fracture most common

Associated Injuries

Rib fracture
Pulmonary contusion
Myocardial contusion (1.5%)
No association between sternal fracture and aortic rupture

Clinical Features

Anterior chest pain
Point tenderness over sternum
Ecchymosis, soft tissue swelling

Differential Diagnosis

Thoracic Trauma

Airway/Pulmonary
Cardiac/Vascular
- Cardiac injury
- Traumatic aortic transection
Musculoskeletal
Other

Evaluation

A displaced sternal fracture as seen on lateral X-ray.

Comminuted sternal fracture on CT

Axial CT showing sternal fracture with retrosternal haematoma (black arrow). Also aortic injury (white arrows).

Workup

CXR or CT

Diagnosis

Most are visible on lateral CXR
CT is test of choice if high suspicion

Management

ECG
Consider troponin

Disposition

Isolated, non-displaced fracture:
- If pain control achieved and ECG normal ok to discharge home
Displaced fracture or concern for severe pain or respiratory compromise:
- Refer for operative fixation

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-*Fracture is MORE likely in restrained passengers than unrestrained passengers
+[[File:Sobo 1909 31.png|thumb|Anatomy of the sternum.]]
-*Isolated sternal fx is relatively benign
+*Fracture is more likely in restrained passengers than unrestrained passengers (high-energy trauma)
+*Isolated sternal fracture is relatively benign
 **Low mortality (<1%)
 **Low intrathoracic morbidity
-*May be associated with:
+*Sternal body fracture most common
-**[[Rib Fracture]], [[Pulmonary Contusion]] (~10%)
-**Myocardial contusion (1.5-6%)
-*No association between sternal fracture and aortic rupture
+===Associated Injuries===
+*[[Rib fracture]]
+*[[Pulmonary contusion]]
+*[[Myocardial contusion]] (1.5%)
+*<u>No</u> association between sternal fracture and aortic rupture
-*sternal fx in 8% of thoracic injuries, seen on pa/lat cxr, many recent studies prove most, if no comorbidities, can be d/c home safely (mort= .8%), chk ekg
+==Clinical Features==
-==Diagnosis==
 *Anterior chest pain
 *Point tenderness over sternum
 *Ecchymosis, soft tissue swelling
-==Work-Up==
+==Differential Diagnosis==
-*Most are visible on LATERAL CXR
+{{Thoracic trauma DDX}}
-**If fx is seen conservative approach is to obtain chest CT to r/o other pathology
-***May be helpful in determining conservative vs surgical fixation
+==Evaluation==
+[[File:DisplacedSternalFracture.jpg|thumb|A displaced sternal fracture as seen on lateral X-ray.]]
+[[File:Sternal fracture CT.jpg|thumb|Comminuted sternal fracture on CT]]
+[[File:PMC3259405 13244 2011 72 Fig25 HTML.png|thumb|Axial CT showing sternal fracture with retrosternal haematoma (black arrow). Also aortic injury (white arrows).]]
+===Workup===
+*[[CXR]] or CT
+===Diagnosis===
+*Most are visible on lateral [[CXR]]
+*CT is test of choice if high suspicion
-==Treatment==
+==Management==
-*Pain control
+*[[ECG]]
+*Consider [[troponin]]
 ==Disposition==
-*Isolated, non-displaced fx:
+*Isolated, non-displaced fracture:
-**If can achieve pain control ok to d/c home
+**If pain control achieved and [[ECG]] normal ok to discharge home
-*Displaced fx or concern for severe pain or respiratory compromise:
+*Displaced fracture or concern for severe pain or respiratory compromise:
 **Refer for operative fixation
 ==See Also==
+*[[Thoracic Trauma]]
 *[[Rib Fracture]]
 *[[Pulmonary Contusion]]
 *[[Traumatic Pneumothorax]]
-==Source==
+==References==
-Rosen's
+<references/>
 [[Category:Trauma]]