Sternal Fracture

Aka: Sternal Fracture, Fractured Sternum, Sternum Fracture

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II. Epidemiology

  1. Uncommon injury associated with Blunt Chest Trauma
  2. Typical patient is an older male

III. Pathophysiology

  1. Mid-sternal Body and Manubrium are most common sites of Sternal Fracture

IV. Causes

  1. High Energy Blunt Chest Trauma (typically Motor Vehicle Accident)
  2. Military combat
  3. Sports Injury
    1. Ball sports (e.g. baseball)
    2. Contact Sports

V. Signs

  1. Pain at Sternum
  2. Focal crepitation over Fracture site
  3. Impaired inspiration (Splinting respirations)

VI. Precautions

  1. Sternal Fracture is a marker of significant, high energy blunt force to the chest

VII. Imaging

  1. Chest XRay
    1. Poor Test Sensitivity for Sternal Fracture
  2. Lateral Sternal XRay
    1. Evaluate for displaced Fracture
  3. CT chest
    1. Sternal Fractures may be difficult to identify even on CT and requires careful inspection to detect

VIII. Labs

  1. Troponin
    1. Obtain at 4-6 hours after Sternal Fracture (3 hours may be sufficient in High Sensitivity Troponin)
    2. First line study in all Sternal Fractures

IX. Diagnostics

  1. Electrocardiogram (EKG)
    1. First line study in all Sternal Fractures (esp. displaced Sternal Fractures)
    2. See Cardiac Contusion for specific findings
  2. Echocardiogram
    1. Echocardiogram is only needed in specific cases (not in all Sternal Fractures)
      1. However initial Bedside Ultrasound FAST Scan may offer global contractility impression
    2. Indications: Sternal Fracture (esp. displaced) AND
      1. Abnormal EKG (e.g. Arrhythmia) or Troponin elevation
      2. Hypotension (or other signs hemodynamic instability)

X. Complications

  1. Rib Fracture
  2. Pulmonary Contusion
  3. Pneumothorax
  4. Hemothorax
  5. Cardiac Contusion or Blunt Cardiac Injury (rare, but potentially life threatening)
    1. Right Ventricle is most commonly injured chamber in Sternal Fracture
    2. Structural injury (Myocardium or valvular injury)
    3. Dysrhythmia
      1. Occurs within first 8-24 hours of injury and typically resolves spontaneously
      2. Atrial Fibrillation is most common

XI. Evaluation

  1. Normal Troponin, EKG, hemodynamic and cardiac monitoring in Emergency Department
    1. Unlikely to have significant cardiac injury related to Sternal Fracture
  2. Abnormal Troponin, EKG or hemodynamic and cardiac monitoring (esp. in displaced Sternal Fracture)
    1. Obtain Echocardiogram to evaluate for structural injuries
    2. Monitor on telemetry for Dysrhythmia

XII. Management: Acute Management

  1. See Primary Trauma Survey
  2. See Secondary Trauma Survey
  3. Cardiovascular monitoring with Oxygen Saturation
  4. Aggressive pain management (prevent respiratory Splinting)
  5. Sternal Fracture uncommonly requires surgical management
  6. Primary attention in Sternal Fractures are to the associated injuries from severe blunt force Chest Trauma

XIII. Management: Surgery

  1. Acute Surgical Management Indications
    1. Overlapping Sternal Fracture edges
    2. Impacted Ventilation
  2. Chronic Surgical Management Indications
    1. Nonunion Sternal Fracture or Pseuodarthrosis resulting in Chronic Pain and dysfunction (esp. athletes)

XIV. Management: Disposition

  1. Stable Sternal Fractures
    1. See Rib Fracture (similar approach to home management)
    2. Treat with pain management and incentive Spirometry
    3. Expect recovery over 8-12 weeks
    4. Follow-up with sports medicine to evaluate for longer term complications (Chronic Pain, dysfunction)
      1. Nonunion Sternal Fracture or Pseuodarthrosis
      2. Consider surgical referral (as above)

XV. References

  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21
  2. Herbert and Inaba in Herbert (2014) EM:Rap 14(11): 1-15

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Related Studies

Ontology: Fracture of sternum (C0238436)

Concepts Injury or Poisoning (T037)
ICD10 S22.2
SnomedCT 208137007, 157197001, 263215002, 208144003, 78516000
Italian Frattura sternale, Sterno fratturato
English Sternum fracture NOS, fracture of sternum (diagnosis), fracture of sternum, Fractured sternum, fractures sternum, sternum fracture, fracture sternum, sternal fracture, fracture sternal, sternum fractured, fractures sternal, Sternum fracture NOS (disorder), Fracture of sternum, Sternal fracture, Fracture of sternum (disorder), fracture; sternum, sternum; fracture, Fracture of sternum, NOS, Sternal fracture, NOS, fractured sternum, Fracture;sternum
Dutch gefractureerd sternum, fractuur; sternum, sternum; fractuur, Fractuur van sternum, borstbeenbreuk
French Sternum fracturé, Fracture du sternum
German gebrochenes Sternum, Fraktur des Sternums, Fraktur des Brustbeins
Portuguese Esterno fracturado, Fractura do esterno
Spanish Esternón fracturado, fractura del esternón, SAI (trastorno), fractura del esternón (trastorno), fractura de esternón, fractura de esternón (trastorno), fractura del esternón, fractura del esternón, SAI, fractura esternal, Fractura esternal
Japanese 胸骨骨折, ｷｮｳｺﾂｺｯｾﾂ
Czech Zlomeniny sterna, Zlomená kost hrudní
Korean 복장뼈의 골절
Hungarian Sternum-törés
Derived from the NIH UMLS (Unified Medical Language System)

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