Presentation
This 54 year old female was a front seat passenger in a car traveling at 100km/h. The car lost control on ice, spun into a ditch and up an embankment. She complained of pleuritic chest pain and was tender on palpation to her anterior chest. A CT chest was performed.
Patient Data
- Comminuted fracture of the sternum, with dislocation of the manubriosternal joint. Small amount of adjacent soft tissue stranding.
- No mediastinal hematoma or great vessel injury identified. No pneumothorax or pulmonary contusions. No pleural or pericardial effusion.
Case Discussion
Sternal trauma, is an uncommon occurrence, typically found in patients with blunt chest trauma or deceleration trauma (from motor vehicle accidents)1. The incidence of sternal fracture is 3-6.8% of motor vehicle collisions1.
Sternal fracture is typically diagnosed with sternal view plain film X-rays. Ultrasound is becoming increasingly used for patients with suspected sternal fracture but indeterminate plain films. The sensitivity is claimed to be 100%2.
Isolated sternal fractures have a good prognosis, low mortality and are commonly treated on an outpatient basis3,4. Concomitant injuries, however, can complicate the issue. These include:
- Soft tissue injuries
- pneumothoraces, hemothoraces, cardiac tamponade, myocardial, pulmonary contusions, abdominal and diaphragmatic injury
- 6-12% of patients with sternal trauma will have an associated myocardial contusion4
- Injuries to the chest wall
- rib fractures, flail chest and sternoclavicular dislocation
- Injuries to the spine, appendages and cranium
Complications from sternal injury include:
- Short term complications - musculoskeletal chest pain requiring analgesia to control. Poorly controlled chest pain can lead to impaired ventilation and pulmonary infection
- Long term complications - non-union, pseudoarthroses
Rare complications include osteomyelitis, sternal abscess formation and mediastinitis.
Management is typically conservative with sternal fractures. Certain sternal fractures do require operative management however. Displaced or unstable chest fractures (such as in this particular case) require operative fixation with sternal wires or osteosynthesis.
Case contributed by A/Prof. Pramit Phal.
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