Rib fractures are a common traumatic occurrence, where the 4th to 9th ribs are most commonly fractured. Superior rib fractures of the 1st to 3rd ribs are more commonly associated with subclavian vasculature as well as brachial plexus injury. More inferior rib fractures of the 10th to 12th ribs are associated with visceral injury, in particular, the spleen, kidney and liver5. In general, the greater the number of fractured ribs, the more severe the causative injury.
Rib fractures can have multiple complications. These include:
- Pulmonary contusions
- Flail chest
Sternal fractures are also relatively uncommon, but are typically found in passengers in motor vehicle accidents (60-90%). The passengers have typically worn a restraining belt, however airbags did nt deploy. Fractures of this area occur either at the sternum, or at the manubrial body - the xyphoid process doesn't usually fracture.
Sternal trauma is an uncommon occurrence, typically found in patients with blunt chest trauma or deceleration trauma (from motor vehicle accidents)1.
Sternal fracture can be diagnosed with sternal view plain film radiography. Ultrasound has recently been 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. Due to the large amount of force associated with these injuries, concomitant injuries are common and can complicate management. Such concomitant injuries 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. In this patient, their aspiration pneumonia may be exacerbated by sternal fracture pain.
- Long term complications - non-union, pseudoarthroses
Rare complications include osteomyelitis, sternal abscess formation and mediastinitis.
Management is typically conservative with sternal fractures. For displaced or unstable chest fractures require operative fixation with sternal wires or osteosynthesis.
Case contributed by A/Prof. Pramit Phal.