Lung

Sternal Fracture

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Sternal Fracture, Fractured Sternum, Sternum Fracture

  • Epidemiology
  1. Uncommon injury associated with Blunt Chest Trauma
  2. Typical patient is an older male
  • Precautions
  1. Sternal Fracture is a marker of significant blunt force to the chest
  • Imaging
  1. Chest XRay
    1. Poor Test Sensitivity for Sternal Fracture
  2. CT chest
    1. Sternal Fractures may be difficult to identify even on CT and requires careful inspection to detect
  • Labs
  1. Troponin
    1. First line study in all Sternal Fractures
  • Diagnostics
  1. Electrocardiogram (EKG)
    1. First line study in all Sternal Fractures
  2. Echocardiogram
    1. Echocardiogram is only needed in specific cases (not in all Sternal Fractures)
    2. Indicated for arrhythmia or Hypotension associated with Sternal Fracture
  • Management
  1. Sternal Fracture uncommonly requires surgical management
  2. Primary attention in Sternal Fractures are to the associated injuries from severe blunt force Chest Trauma
  • Evaluation
  1. Normal Troponin and EKG
    1. Unlikely to have significant cardiac injury related to Sternal Fracture
  2. Abnormal Troponin or EKG
    1. Obtain Echocardiogram to evaluate for structural injuries
    2. Monitor on telemetry for dysrhythmia
  • Complications
  1. Rib Fracture
  2. Pulmonary Contusion
  3. Pneumothorax
  4. Hemothorax
  5. Blunt Cardiac Injury (rare)
    1. Structural injury (Myocardium or valvular injury)
    2. Dysrhythmia
      1. Occurs within first 8-24 hours of injury and typically resolves spontaneously
      2. Atrial Fibrillation is most common
  • References
  1. Herbert and Inaba in Herbert (2014) EM:Rap 14(11): 1-15