Radiography
Lateral radiograph of the normal sternum.
Frontal radiograph of the normal sternum.
Lateral radiograph demonstrates complete dislocation at the sternal angle. (Also see Image below.)
Upright frontal radiograph in the same patient as in Image above shows mild widening of the superior mediastinum after blunt trauma to the chest.
Supine frontal radiograph after significant blunt trauma to the anterior chest wall shows marked mediastinal widening. (Also see Image below.)
Lateral radiograph shows a complete displaced fracture of the sternum (arrow) (same patient as in Image above).
Findings
The lateral radiograph is usually the most valuable view for detecting sternal fractures and for determining the degree of displacement (see Images above and Images 1-2, 6-9 in Multimedia).7
Degree of Confidence
Almost all patients with sternal fractures complain of localized sternal pain. Therefore, correlation with the clinical presentation is important.
False Positives/Negatives
Nonunited ossification centers and failure of bony fusion of the sternomanubrial and sternoxiphoid articulations can simulate fractures; the angulation is variable at both of these sites.
Computed Tomography
Findings
CT scan studies were initially less sensitive than plain radiography. The newer generation of MDCT scanning units now allow for multiplanar and 3-D reconstruction, which greatly improve accuracy. CT scanning provides superior sensitivity and specificity but at a greater cost and with more radiation exposure.
CT scanning is particularly useful to assess patients with sternal fractures for associated injuries such as pulmonary contusion, pneumothorax, or retrosternal hematoma.
Ultrasonography
Findings
Ultrasonography is a useful way to demonstrate fractures of the sternum.8,9,10
Degree of Confidence
The sensitivity of ultrasonography is comparable to that of plain radiography, but conventional radiography remains the standard means of documenting a sternal fracture.
Nuclear Imaging
Nuclear bone scan of fractures of the sternum (arrow) and of the ribs on the right side (arrowheads).
Findings
Nuclear bone scanning may be needed if the initial radiographic findings are not definitive (see Image above and Image 5 in Multimedia).
Degree of Confidence
Total-body bone scans are sensitive for acute sternal trauma. However, the anatomic detail is limited, and correlation with the results of radiography or CT scanning is often necessary.
More on Sternum, Fractures |
| Overview: Sternum, Fractures |
 Imaging: Sternum, Fractures |
| Multimedia: Sternum, Fractures |
| References |
| Further Reading |
| « Previous Page | Next Page » |
References
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Zeng Q, Lai JY, Wang XM, Lee JL, Chia ST, Wang CJ, et al. Costochondral changes in the chest wall after the Nuss procedure: ultrasonographic findings. J Pediatr Surg. Dec 2008;43(12):2147-50. [Medline].
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Keywords
sternum fractures, sternal fractures, breastbone, chest trauma, chest injury
