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:
Consideration of an analgesic
Trauma care as warranted by protocol for any suspected associated injuries
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.
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]
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.  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.
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.
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