Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Sternal Fracture Treatment & Management

  • Author: Scott Felten, MD, FACEP; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: May 25, 2016
 

Prehospital Care

Initiate basic or advanced trauma care based on the level of training of the ambulance crew and initial assessment.

Care should include the following steps:

  • Supplemental oxygen
  • Cardiac monitoring
  • Intravenous access
  • Consideration of an analgesic
  • Trauma care as warranted by protocol for any suspected associated injuries
Next

Emergency Department Care

After immediate stabilization, evaluate the patient by obtaining a complete history and physical examination.

Taping or splinting of sternal fractures is contraindicated, as restriction of normal chest expansion during respiration can lead to atelectasis and pulmonary insufficiency.

Adequate analgesia is the treatment of choice, both during initial care and subsequently during the recovery period.

Encouragement of deep breathing decreases pulmonary complications during recovery.

Previous
Next

Consultations

Consult a trauma surgeon when serious associated injury is diagnosed or suspected.

Surgical fixation for sternal fractures is generally unnecessary, although a recent study suggests that a more rapid recovery can be made if painful unstable fractures are fixated early rather than allowing them to heal over time.[15, 16, 17]

Previous
Next

Medical Care

Numerous studies demonstrate that admission for isolated sternal fracture is not generally necessary unless associated injuries or social situations require such considerations.[18, 15, 19, 20]

One study suggests that patients with pain that is difficult to control with outpatient analgesics should be considered for admission and be given a continuous infusion of an anesthetic via a subperiosteal catheter.[21] Improved respiratory function was noted with this technique; however, it may not be readily available at most sites.

Consider at least an observation admission for elderly persons with chest wall fractures because these patients are at increased risk for respiratory compromise and atelectasis.

Previous
Next

Complications

Complications may arise from associated injuries. During evaluation of these patients, carefully assess for cardiac, pulmonary, mediastinal, and thoracic spine injuries, as well as associated injuries unrelated to chest trauma.

Cardiac contusion is much less common than once thought; its incidence currently ranges from 6-18% based on severity of trauma.

Traumatic aortic injury occurs in fewer than 2% of sternal fractures, a rate similar to that in patients with blunt chest trauma without sternal fracture.

Nonunion of sternal fractures is very rare. Painful pseudoarthroses occur when a false joint develops secondary to failed union of a fracture and may require delayed surgical repair. Similarly, overlap deformities may require delayed surgical repair.

A posttraumatic mediastinal abscess is very uncommon. Risk factors include the presence of a large hematoma, intravenous drug abuse, and another source of a staphylococcal infection. Treatment is open debridement.

Previous
 
 
Contributor Information and Disclosures
Author

Scott Felten, MD, FACEP Residency Director for Emergency Medicine Physicians, 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, 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

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

David B Levy, DO, FAAEM Senior Consultant in Emergency Medicine, Waikato District Health Board, New Zealand; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

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

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Acknowledgements

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.

References
  1. Khoriati AA, Rajakulasingam R, Shah R. Sternal fractures and their management. J Emerg Trauma Shock. 2013 Apr. 6 (2):113-6. [Medline].

  2. Schulz-Drost S, Oppel P, Grupp S, Taylor D, Krinner S, Langenbach A, et al. The oblique fracture of the manubrium sterni caused by a seatbelt-a rare injury? Treatment options based on the experiences gained in a level I trauma centre. Int Orthop. 2015 May 10. [Medline].

  3. Recinos G, Inaba K, Dubose J, Barmparas G, Teixeira PG, Talving P, et al. Epidemiology of sternal fractures. Am Surg. 2009 May. 75(5):401-4. [Medline].

  4. Knobloch K, Wagner S, Haasper C, Probst C, Krettek C, Otte D, et al. Sternal fractures occur most often in old cars without any airbag often with concomitant spinal injuries: clinical findings and technical collision variables among 42,055 crash victims. Ann Thorac Surg. 2006 Aug. 82(2):444-50. [Medline].

  5. Weaver AA, Schoell SL, Nguyen CM, Lynch SK, Stitzel JD. Morphometric analysis of variation in the sternum with sex and age. J Morphol. 2014 Nov. 275 (11):1284-99. [Medline].

  6. Hechter S, Huyer D, Manson D. Sternal fractures as a manifestation of abusive injury in children. Pediatr Radiol. 2002 Dec. 32(12):902-6. [Medline].

  7. Karangelis D, Bouliaris K, Koufakis T, Spiliopoulos K, Desimonas N, Tsilimingas N. Management of isolated sternal fractures using a practical algorithm. J Emerg Trauma Shock. 2014 Jul. 7 (3):170-3. [Medline].

  8. Lahham S, Patane J, Lane N. Ultrasound of Sternal Fracture. West J Emerg Med. 2015 Dec. 16 (7):1057-8. [Medline].

  9. Jin W, Yang DM, Kim HC, Ryu KN. Diagnostic value of sonography for assessment of sternal fractures compared with conventional radiograaphy and bone scans. J Ultrasound Med. 2006. 25:

  10. Racine S, Drake D. BET 3: Bedside ultrasound for the diagnosis of sternal fracture. Emerg Med J. 2015 Dec. 32 (12):971-2. [Medline].

  11. Miller PR, Croce MA, Bee TK, et al. ARDS after pulmonary contusion: accurate measurement of contusion volume identifies high risk patients. J Trauma. 2001. 51:223:

  12. Perez MR, Rodriguez RM, Baumann BM, Langdorf MI, Anglin D, Bradley RN, et al. Sternal fracture in the age of pan-scan. Injury. 2015 Jul. 46 (7):1324-7. [Medline].

  13. Chiu WC, D'Amelio LF, Hammond JS. Sternal fractures in blunt chest trauma: a practical algorithm for management. Am J Emerg Med. 1997 May. 15(3):252-5. [Medline].

  14. Wright SW. Myth of the dangerous sternal fracture. Ann Emerg Med. 1993 Oct. 22(10):1589-92. [Medline].

  15. Potaris K, Gakidis J, Mihos P, Voutsinas V, Deligeorgis A, Petsinis V. Management of sternal fractures: 239 cases. Asian Cardiovasc Thorac Ann. 2002 Jun. 10(2):145-9. [Medline].

  16. Gallo DR, Lett ED, Conner WC. Surgical repair of a chronic traumatic sternal fracture. Ann Thorac Surg. 2006 Feb. 81(2):726-8. [Medline].

  17. Schulz-Drost S, Oppel P, Grupp S, Schmitt S, Carbon RT, Mauerer A, et al. Surgical fixation of sternal fractures: preoperative planning and a safe surgical technique using locked titanium plates and depth limited drilling. J Vis Exp. 2015 Jan 5. e52124. [Medline].

  18. Bar I, Friedman T, Rudis E, Shargal Y, Friedman M, Elami A. Isolated sternal fracture--a benign condition?. Isr Med Assoc J. 2003 Feb. 5(2):105-6. [Medline].

  19. Peek GJ, Firmin RK. Isolated sternal fracture: an audit of 10 years' experience. Injury. 1995 Jul. 26(6):385-8. [Medline].

  20. Sadaba JR, Oswal D, Munsch CM. Management of isolated sternal fractures: determining the risk of blunt cardiac injury. Ann R Coll Surg Engl. 2000 May. 82(3):162-6. [Medline].

  21. Duncan MA, McNicholas W, O'Keeffe D, O'Reilly M. Periosteal infusion of bupivacaine/morphine post sternal fracture: a new analgesic technique. Reg Anesth Pain Med. 2002 May-Jun. 27(3):316-8. [Medline].

  22. Brookes JG, Dunn RJ, Rogers IR. Sternal fractures: a retrospective analysis of 272 cases. J Trauma. 1993 Jul. 35(1):46-54. [Medline].

  23. Athanassiadi K, Gerazounis M, Moustardas M, Metaxas E. Sternal fractures: retrospective analysis of 100 cases. World J Surg. 2002 Oct. 26(10):1243-6. [Medline].

  24. Breederveld RS, Patka P, van Mourik JC. Fractures of the sternum. Neth J Surg. 1988 Oct. 40(5):133-5. [Medline].

  25. Bu'Lock FA, Prothero A, Shaw C, Parry A, Dodds CA, Keenan J, et al. Cardiac involvement in seatbelt-related and direct sternal trauma: a prospective study and management implications. Eur Heart J. 1994 Dec. 15(12):1621-7. [Medline].

  26. Budd JS. Isolated sternal fracture: a benign injury?. Injury. 1993 Aug. 24(7):501. [Medline].

  27. Calhoon JH, Grover FL, Trinkle JK. Chest trauma. Approach and management. Clin Chest Med. 1992 Mar. 13(1):55-67. [Medline].

  28. Carey S, Pezzella AT, Gilliam H. Traumatic sternal fractures: current concepts in diagnosis and management. Mil Med. 1988 Sep. 153(9):451-3. [Medline].

  29. Crestanello JA, Samuels LE, Kaufman MS, Thomas MP, Talucci R. Sternal fracture with mediastinal hematoma: delayed cardiopulmonary sequelae. J Trauma. 1999 Jul. 47(1):161-4. [Medline].

  30. Cuschieri J, Kralovich KA, Patton JH, Horst HM, Obeid FN, Karmy-Jones R. Anterior mediastinal abscess after closed sternal fracture. J Trauma. 1999 Sep. 47(3):551-4. [Medline].

  31. Ferguson LP, Wilkinson AG, Beattie TF. Fracture of the sternum in children. Emerg Med J. 2003 Nov. 20(6):518-20. [Medline].

  32. Gouldman JW, Miller RS. Sternal fracture: a benign entity?. Am Surg. 1997 Jan. 63(1):17-9. [Medline].

  33. Harley DP, Mena I. Cardiac and vascular sequelae of sternal fractures. J Trauma. 1986 Jun. 26(6):553-5. [Medline].

  34. Hendrich C, Finkewitz U, Berner W. Diagnostic value of ultrasonography and conventional radiography for the assessment of sternal fractures. Injury. 1995 Nov. 26(9):601-4. [Medline].

  35. Heyes FL, Vincent R. Sternal fracture: what investigations are indicated?. Injury. 1993 Feb. 24(2):113-5. [Medline].

  36. Hills MW, Delprado AM, Deane SA. Sternal fractures: associated injuries and management. J Trauma. 1993 Jul. 35(1):55-60. [Medline].

  37. Holcomb JB, McMullin NR, Kozar RA, Lygas MH, Moore FA. Morbidity from rib fractures increases after age 45. J Am Coll Surg. 2003 Apr. 196(4):549-55. [Medline].

  38. Huggett JM, Roszler MH. CT findings of sternal fracture. Injury. 1998 Oct. 29(8):623-6. [Medline].

  39. Jackimczyk K. Blunt chest trauma. Emerg Med Clin North Am. 1993 Feb. 11(1):81-96. [Medline].

  40. Johnson I, Branfoot T. Sternal fracture--a modern review. Arch Emerg Med. 1993 Mar. 10(1):24-8. [Medline].

  41. Jones A. Towards evidence based emergency medicine: best BETS from the Manchester Royal Infirmary. Admission of isolated sternal fracture for observation. J Accid Emerg Med. 1998 Jul. 15(4):227-8. [Medline].

  42. Lederer W, Mair D, Rabl W, Baubin M. Frequency of rib and sternum fractures associated with out-of-hospital cardiopulmonary resuscitation is underestimated by conventional chest X-ray. Resuscitation. 2004 Feb. 60(2):157-62. [Medline].

  43. Lin KH, Ponampalam R. Sternum insufficiency fracture presenting as acute chest pain: a case report and review of the literature. Eur J Emerg Med. 2006 Apr. 13(2):122-4. [Medline].

  44. Miller LA. Chest wall, lung, and pleural space trauma. Radiol Clin North Am. 2006. 44 (2):213-244.

  45. Ohry A. Sternal fractures. J Trauma. 1995 Mar. 38(3):463-4. [Medline].

  46. Perron AD. Chest pain in athletes. Clin Sports Med. 2003 Jan. 22(1):37-50. [Medline].

  47. Purkiss SF, Graham TR. Sternal fractures. Br J Hosp Med. 1993 Jul 14-Aug 17. 50(2-3):107-12. [Medline].

  48. Rashid MA, Ortenwall P, Wikstrom T. Cardiovascular injuries associated with sternal fractures. Eur J Surg. 2001 Apr. 167(4):243-8. [Medline].

  49. Roy-Shapira A, Levi I, Khoda J. Sternal fractures: a red flag or a red herring?. J Trauma. 1994 Jul. 37(1):59-61. [Medline].

  50. Sarkar PK, Counsell D, Rabbi F. Fractures of the sternal body. Ann R Coll Surg Engl. 1993 May. 75(3):213-4. [Medline].

  51. Schapira D, Nachtigal A, Scharf Y. Spontaneous fracture of the sternum simulating myocardial infarction. Clin Rheumatol. 1995 Jul. 14(4):478-80. [Medline].

  52. Van Hise ML, Primack SL, Israel RS, Muller NL. CT in blunt chest trauma: indications and limitations. Radiographics. 1998 Sep-Oct. 18(5):1071-84. [Medline].

  53. Velissaris T, Tang AT, Patel A, Khallifa K, Weeden DF. Traumatic sternal fracture: outcome following admission to a Thoracic Surgical Unit. Injury. 2003 Dec. 34(12):924-7. [Medline].

  54. Vioreanu MH, Quinlan JF, Robertson I, O'Byrne JM. Vertebral fractures and concomitant fractures of the sternum. Int Orthop. 2005 Dec. 29(6):339-42. [Medline].

  55. Watts RA, Paice EW, White AG. Spontaneous fracture of the sternum and sternal tuberculosis. Thorax. 1987 Dec. 42(12):984-5. [Medline].

  56. Wiener Y, Achildiev B, Karni T, Halevi A. Echocardiogram in sternal fracture. Am J Emerg Med. 2001 Sep. 19(5):403-5. [Medline].

  57. Wojcik JB, Morgan AS. Sternal fractures--the natural history. Ann Emerg Med. 1988 Sep. 17(9):912-4. [Medline].

  58. Yilmaz EN, van Heek NT, van der Spoel JI, Bakker FC, Patka P, Haarman HJ. Myocardial contusion as a result of isolated sternal fractures: a fact or a myth?. Eur J Emerg Med. 1999 Dec. 6(4):293-5. [Medline].

 
Previous
Next
 
Posterior surface of the sternum.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.