Insufficiency fracture of the sternum

Case contributed by Dr. Chris O'Donnell


PH of carcinoma of the breast. Routine follow-up includes abnormal bone scan. Taking risedronate for osteoporosis (DEXA T score -2.6 left neck of femur).

Patient Data

Age: 75
Gender: Female
Nuclear medicine

Focal, isolated, intense, hot spot in the mid sternal body of this whole body bone scan without any other abnormal isotope accumulation in bone apart from the acromio-clavicular joints.

Sclerotic lesion in the mid sternum with a central linear defect indicative of a healing fracture. Biopsy showed mature trabecular bone with fibrosis and hemosiderin, osteoid, chondral elements and immature bone. No occult malignant cells on immunoperoxide staining.

Case Discussion

Insufficiency fractures of the sternum are rare in osteoporosis and were said to result from excessive forces on the sternum in elderly patients with kyphosis although this has been refuted 1.  CT findings are typical of any fracture with a linear defect (with or without buckling of the cortex) and surrounding sclerosis (healing).

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