Sternal fracture: Difference between revisions
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==Background== | ==Background== | ||
*Fracture is more likely in restrained passengers than unrestrained passengers | *Fracture is more likely in restrained passengers than unrestrained passengers | ||
*Isolated sternal | *Isolated sternal fracture is relatively benign | ||
**Low mortality (<1%) | **Low mortality (<1%) | ||
**Low intrathoracic morbidity | **Low intrathoracic morbidity | ||
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*Isolated, non-displaced fx: | *Isolated, non-displaced fx: | ||
**If pain control achieved and ECG normal ok to discharge home | **If pain control achieved and ECG normal ok to discharge home | ||
*Displaced | *Displaced fracture or concern for severe pain or respiratory compromise: | ||
**Refer for operative fixation | **Refer for operative fixation | ||
Revision as of 05:32, 3 July 2016
Background
- Fracture is more likely in restrained passengers than unrestrained passengers
- Isolated sternal fracture is relatively benign
- Low mortality (<1%)
- Low intrathoracic morbidity
- May be associated with:
- 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
Diagnosis
- Imaging
- Most are visible on lateral CXR or on ultrasound
Management
- ECG
- Consider troponin
- Surgeons tend to want trop
- ED providers tend to defer trop if ECG nl
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Disposition
- Isolated, non-displaced fx:
- 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