Sternal fractures occur in ~5% of blunt chest trauma with the manubrium being the most commonly injured part.
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Epidemiology
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.
Associations
Associated injuries are common, occurring in ~50% (range 33-67%) of patients 1,3:
- rib fractures, sternoclavicular joint dislocation
- mediastinal hemorrhage, pneumothorax, hemothorax, cardiac tamponade, cardiac contusion, pulmonary contusion
- thoracic spine compression fracture
- traumatic brain injury (TBI)
Clinical presentation
Acute, severe sternal pain that is worse with respiration with localized tenderness.
Pathology
Mechanism of injury
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:
- direct: impact on a steering wheel; falls; contact sports; pedestrian vs car accidents; assaults
- indirect: deceleration injuries from motor vehicle accidents; stress fractures; osteoporotic fractures
- non-accidental injuries in children
- cardiopulmonary resuscitation (CPR)
Radiographic features
Plain radiograph
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.
US
- 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
CT
- 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
Treatment and prognosis
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.
Differential diagnosis
- sternal foramen: developmental anomaly found in ~5% of the population
- motion/breathing artifact: usually on CT sagittal reformat
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