Introduction
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.
Background
Sternal fractures are often seen in association with deceleration injuries and/or direct blows to the chest, and they occur in approximately 3% of patients suffering blunt chest trauma.1 The introduction of seat-belt legislation has resulted in an increased frequency of these types of injuries.2
Most sternal fractures occur in the midbody, and they are typically transverse. Manubrial fractures are the next most common. Stress fractures are occasionally seen in athletes such as wrestlers, but they can also occur in women with osteoporosis and kyphotic thoracic spines.
Related eMedicine topics:
Blunt Chest Trauma
Flail Chest
Fracture, Sternal
Frequency
United States
Motor vehicle accidents account for the vast majority of sternal fractures.
Mortality/Morbidity
An increased mortality rate has been reported with sternal fractures as a result of associated chest injuries, such as cardiac contusion, aortic rupture, pulmonary contusion, and thoracic spine compression fractures. However, more recent literature suggests an associated mortality rate of less than 1%.3,4
Race
No racial predilection exists.
Sex
No definite sexual predilection exists.
Age
A large study from Greece showed that patients with sternum fractures have a mean age of 50.3 years (range, 15-93 y).4
Presentation
Natural history and presentation
Anatomy
The sternum has 3 parts: the manubrium, the body (corpus), and the xiphoid process (tip) (see Images below and Images 3-4 in Multimedia).5
(Click Image to enlarge.) Posterior surface of the sternum.
(Click Image to enlarge.) Lateral border of the sternum.
The manubrium lies at the level of the third (T3) and fourth thoracic (T4) vertebrae. Along the superior margin of the manubrium is the suprasternal or jugular notch. Both the clavicle and the first rib articulate with the manubrium, and the sternal head of the sternocleidomastoid muscle inserts onto this portion of the sternum.
The joint between the manubrium and the body, the manubriosternal joint, forms the sternal angle, which is at the level of the second rib. In older people, this joint tends to be fused.
The xiphoid process is cartilaginous in younger people and ossified in older people.
Etiology
Most sternal fractures are caused by blunt anterior chest trauma and have a risk of associated thoracic, mediastinal, or cardiac injury. Sternal fractures have also been reported in association with sports activities such as golf and weight lifting but are less frequently seen in association with cardiopulmonary resuscitation.6
Trauma patients presenting to a hospital with sternal fractures are usually admitted for monitoring for possible associated blunt cardiac injury. The monitoring usually entails serial determination of cardiac enzyme levels (creatine phosphokinase–MB [CPK-MB]) and electrocardiography (ECG).
Preferred Examination
The routine radiologic study of the sternum consists of a lateral projection and frontal views, which are obtained with the patient prone and rotated slightly off the midline in each direction. Normal anatomic variants, such as nonunited ossification centers, may sometimes cause a diagnostic dilemma.
Limitations of Techniques
Initially, computed tomography (CT) scan studies were less sensitive than plain radiographs. However, the newer generation of multidetector-row CT (MDCT) scanning units now allow for multiplanar and 3-dimensional (3-D) reconstruction, which greatly improve accuracy.
CT scanning provides superior sensitivity and specificity but at greater cost and with increased radiation exposure.
Ultrasonography has been proven to be as accurate as radiography in diagnosing sternal fractures. However, lateral radiographs remain the standard means of demonstrating the grade of sternal displacement.
Differential Diagnoses
Other Problems to Be Considered
Cardiac contusion
Pulmonary contusion
More on Sternum, Fractures |
 Overview: Sternum, Fractures |
| Imaging: Sternum, Fractures |
| Multimedia: Sternum, Fractures |
| References |
| Further Reading |
| Next Page » |
References
Brookes JG, Dunn RJ, Rogers IR. Sternal fractures: a retrospective analysis of 272 cases. J Trauma. Jul 1993;35(1):46-54. [Medline].
Budd JS. Effect of seat belt legislation on the incidence of sternal fractures seen in the accident department. Br Med J (Clin Res Ed). Sep 21 1985;291(6498):785. [Medline]. [Full Text].
Bar I, Friedman T, Rudis E, Shargal Y, Friedman M, Elami A. Isolated sternal fracture--a benign condition?. Isr Med Assoc J. Feb 2003;5(2):105-6. [Medline].
Potaris K, Gakidis J, Mihos P, Voutsinas V, Deligeorgis A, Petsinis V. Management of sternal fractures: 239 cases. Asian Cardiovasc Thorac Ann. Jun 2002;10(2):145-9. [Medline].
Gray H. Anatomy of the human body. Available at http://www.bartleby.com/107/. Accessed February 21, 2007.
Hashimoto Y, Moriya F, Furumiya J. Forensic aspects of complications resulting from cardiopulmonary resuscitation. Leg Med (Tokyo). Mar 2007;9(2):94-9. [Medline]. [Full Text].
Yoganandan N, Pintar FA, Gennarelli TA, Martin PG, Ridella SA. Chest deflections and injuries in oblique lateral impacts. Traffic Inj Prev. Jun 2008;9(2):162-7. [Medline].
Jin W, Yang DM, Kim HC, Ryu KN. Diagnostic values of sonography for assessment of sternal fractures compared with conventional radiography and bone scans. J Ultrasound Med. Oct 2006;25(10):1263-8; quiz 1269-70.
Yoon D, Hoftman N, Ren W, Esmailian F, Schmidt P, Mahajan A. Intraoperative transesophageal echocardiography in chest trauma. J Trauma. Oct 2008;65(4):924-6. [Medline].
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].
Huggett JM, Roszler MH. CT findings of sternal fracture. Injury. Oct 1998;29(8):623-6. [Medline].
Ohry A. Sternal fractures. J Trauma. Mar 1995;38(3):463-4. [Medline].
Roy-Shapira A, Levi I, Khoda J. Sternal fractures: a red flag or a red herring?. J Trauma. Jul 1994;37(1):59-61. [Medline].
Keywords
sternum fractures, sternal fractures, breastbone, chest trauma, chest injury
