Sternal fracture

Last revised by Dr Daniel J Bell on 22 Jun 2021

Sternal fractures occur in ~5% of blunt chest trauma with the manubrium being the most commonly injured part.

Fractures of the sternum are seen in between 3-6.8% of all motor vehicle collisions 1.

Cardiopulmonary resuscitation (CPR) often results in sternal fractures, one autopsy-based study found sternal fractures in 18% patients, 85% in the sternal body 7.

Associated injuries are common, occurring in ~50% (range 33-67%) of patients 1,3:

Acute, severe sternal pain that is worse with respiration with localized tenderness.

Fractures of the sternum can result from both direct and indirect blunt force trauma to the chest with motor vehicle collisions the most common cause 1,3:

Sternal fractures are best detected on dedicated lateral sternal views as lucent cortical breaches with or without displacement. Undisplaced fractures are poorly visualized on plain x-rays.

  • can also be used to assess for sternal fractures
  • as with plain x-ray, US may show a cortical fracture or step
  • just as accurate as lateral radiographs but less reliable in determining displacement 5
  • modality of choice; sagittal reformat most sensitive
  • can assess for anterior cortical breach and posterior cortical breach, with the latter being associated with more severe neurovascular injuries 3

Isolated sternal injuries have a very good outcome with conservative management, with most healing in a few months with a very low mortality rate (<1%) 1. However, sternal fractures associated with other injuries have a higher mortality rate.

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Cases and figures

  • Case 1: with T3 fracture
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  • Case 2: on ultrasound
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  • Case 3
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  • Case 4: on ultrasound
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  • Case 5: displaced
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  • Case 6: with thoracic spine fracture
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  • Case 8: non-united body fracture
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  • Case 9
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  • Case 10
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  • Case 11
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  • Case 12
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  • Case 13
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