Sternal fracture

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
  • Bronchial injury
  • Diaphragmatic trauma
  • Hemothorax
  • Pneumomediastinum
  • Pulmonary contusion
  • Tracheal injury
  • Trachobronchial injury
  • Traumatic pneumothorax
    • Tension pneumothorax
• Cardiac/Vascular
  • Cardiac injury
    • Blunt cardiac injury
      • Cardiac contusion
      • Commotio cordis
    • Penetrating cardiac injury
    • Cardiac tamponade
  • Traumatic aortic transection
• Musculoskeletal
  • Clavicle fracture
    • Clavicle fracture (peds)
  • Rib fracture
    • Flail chest
  • Scapular fracture
  • Scapulothoracic dissociation
  • Sternoclavicular dislocation
  • Sternum fracture
  • Thoracic and lumbar fractures and dislocations
• Other
  • Esophageal injury or Perforation
  • Pneumomediastinum
  • Pneumopericardium
  • Traumatic asphyxia

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

See Also

• Thoracic Trauma
• Rib Fracture
• Pulmonary Contusion
• Traumatic Pneumothorax