II. Epidemiology

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

III. Causes

  1. Blunt Chest Trauma (typically motor vehicle accident)

IV. Precautions

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

V. 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

VI. Labs

  1. Troponin
    1. First line study in all Sternal Fractures

VII. 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

VIII. 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

IX. 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

X. 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

XI. References

  1. Herbert and Inaba in Herbert (2014) EM:Rap 14(11): 1-15

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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