Sternal Fracture 

  • Author: Scott Felten, MD, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jan 7, 2010
 

Background

Sternal fractures were once thought to be high-morbidity injuries, with a mortality rate of 25-45% from associated injuries. Recent literature reveals that the morbidity rate may be lower, yet caution is warranted when evaluating and treating patients with this injury.

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Pathophysiology

Most sternal fractures are caused by blunt anterior chest trauma, although stress fractures have been noted in golfers, weight lifters, and other participants in noncontact sports. Insufficiency fractures caused by abnormally decreased bone density or weakened bone can occur spontaneously in patients with osteoporosis or osteopenia (particularly in older persons), those on long-term steroid therapy, or those with severe thoracic kyphosis. Cardiopulmonary resuscitation commonly causes rib and sternal fractures, something that must be considered during the recovery process from the illness that led to the cardiac arrest.

Surface anatomy of the sternum is shown in the illustration below.

Posterior surface of the sternum. Posterior surface of the sternum.
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Epidemiology

Frequency

United States

Motor vehicle collisions account for 60-90% of sternal fractures.[1] Most of these are in older vehicles in which a seat belt is used but no airbag deploys.[2] Those who were unrestrained generally sustained injury from ejection from the vehicle or impact with the steering wheel or dashboard. Direct impact sports, falls, vehicle-to-pedestrian accidents, and assaults account for most of the rest. Spontaneous fractures and stress fractures are rare.

Mortality/Morbidity

The mortality rate from isolated sternal fracture is extremely low. Death and morbidity are related almost entirely to associated injuries such as aortic disruption, cardiac contusion, and pulmonary contusion, or unrelated injuries to the abdomen or head sustained in the accident.

Race

No racial predilection is known.

Sex

Sternal fractures are slightly more common in females than in males, possibly because of shoulder restraint positioning; however, the difference is small.

Age

Sternal fractures are more common in patients older than 50 years, possibly because of a weaker or inelastic bony thorax. Because of the elasticity of their chest walls, children less commonly have sternal fractures; however, when present, the underlying injuries may be more severe.

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Contributor Information and Disclosures
Author

Scott Felten, MD, FACEP  Assistant Professor, Department of Emergency Medicine, University of Oklahoma College of Medicine; Attending Physician, Emergency Medicine Physicians, St Francis Medical Center

Scott Felten, MD, FACEP, is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Mark S Slabinski, MD, FACEP, FAAEM  Vice President, EMP Medical Group

Mark S Slabinski, MD, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Ohio State Medical Association

Disclosure: Nothing to disclose.

Mark B Sigler, MD  Resident Physician, Department of Emergency Medicine, University of Oklahoma College of Medicine, Tulsa

Disclosure: Nothing to disclose.

Specialty Editor Board

Michelle Ervin, MD  Chair, Department of Emergency Medicine, Howard University Hospital

Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

David B Levy, DO, FACEP, FAAEM  Chairman, Department of Emergency Medicine, St Elizabeth Health Center; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Informatics Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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Posterior surface of the sternum.
 
 
 
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