Sternal Fracture

Sternal Fracture

David Ray Velez, MD

Table of Contents

Background
Presentation and Diagnosis
Treatment

See Also:
*See Blunt Cardiac Injury (BCI)

Background

Anatomy

  • Manubrium – Upper Quadrangular Portion
    • Joins the Clavicle and Upper 1.5 Ribs
  • Body (Gladiolus) – Middle Longest Portion
    • Attachment of the Pectoralis Major
    • Articulates with the Majority of the True Ribs
  • Xiphoid Process – Inferior Tip

Fracture Site

  • Body: 55.8% – Most Common
  • Manubrium: 31.7%
  • Body and Manubrium: 12.5%

Most Commonly Caused by Blunt Anterior Chest Wall Trauma and Deceleration Injuries

Motor Vehicle Crash (MVC) is the Most Common Cause (68%) – Increased Incidence Since the Introduction of Seat Belt Laws Requiring Shoulder Restraints

Can Be Caused by Cardiopulmonary Resuscitation (CPR) – 18% Incidence in One Autopsy-Based Study

Mortality

  • Isolated Sternal Fracture: 0.4-3.5%
  • Polytrauma: 3.8-10.4%

Sternum

Presentation and Diagnosis

Significant Force Required to Fracture and the Majority (73.6%) Have Polytrauma with Multiple Injuries

Most Common Associated Injuries

  • Rib Fracture (57.8%) – Most Common
  • Lung Contusion (33.7%)
  • Pneumothorax (22.0%)
  • Vertebral Fracture (21.6%)
  • Lumbar Vertebrae Fracture (16.9%)
  • Concussion (3.9%)
  • Blunt Cardiac Injury (3.6%)

Sternal Fracture Alone Does Not Predict the Presence of Blunt Cardiac Injury (BCI) – Previously Believed to Be – *See Blunt Cardiac Injury (BCI)

Presentation

  • Chest Pain – Worse with Movement, Deep Breathing, or Cough
  • Clicking Sensation with Movement
  • Shortness of Breath
  • Swelling or Ecchymosis
  • Palpable Deformity or Crepitus

Diagnosis

  • CT is the Standard Diagnostic Evaluation
    • Generally Best Seen on Sagittal Imaging and May Be Missed if Looking at Axial Images Alone
  • Chest X-Ray Has Low Sensitivity
    • AP: 50%
    • Lateral: 70%
  • US Has Similar Sensitivity to Plain Radiography

Sternal Fracture

Treatment

Primarily Treated by Nonoperative Management

Most Isolated Sternal Fractures Heal Spontaneously with Pain Lasting an Average of 10.9 Weeks

Surgical Stabilization (Open Reduction and Internal Fixation/ORIF)

  • Rarely Performed
  • Indications for Surgical Stabilization are Poorly Established Compared to Rib Fractures
  • Potential Indications:
    • Visible Deformity
    • Loss of Sternal Continuity
    • Complete Displacement
    • Sternomanubrial Joint Dislocation/Fracture
    • Persistent Mobility/Clicking
    • Uncontrolled Pain
    • Chronic Pain or Nonunion
  • Generally Performed Using Titanium Plates