Sternal Fracture Workup

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

Laboratory Studies

  • In general, laboratory studies are not indicated for evaluation of isolated sternal injuries, though consider appropriate laboratory studies in evaluation of potential associated injuries.
  • Creatine kinase (CK)-MB index and other enzyme markers of cardiac injury are helpful if cardiac contusion is suspected. However, the routine use of this test is not indicated. Remember that total CK may be elevated from other noncardiac muscle injuries.
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Imaging Studies

  • Radiographs
    • Plain radiography remains the diagnostic tool of choice.
    • Although standard posteroanterior and lateral chest radiographs may reveal fracture, sternal views are necessary if injury is suspected from physical examination.
    • Be aware of normal ossification centers that normally close by the late teenage years, though sternomanubrial and sternoxiphoid centers may never fuse in 10-30% of patients.
    • Sternal views enhance visualization of the sternum, since they change the angle and focus of the exposure. Obtain these views if highly suspicious for injury and no fracture is seen on chest radiograph.
  • Ultrasonography: Ultrasonography demonstrates sternal fractures with as much sensitivity as plain radiography, although this should not be considered the imaging test of first choice.
  • Computed tomography
    • CT scanning may reveal this injury yet is less sensitive than plain radiography, as the fracture may be positioned between image cuts.
    • CT scans may demonstrate retrosternal hematoma; although its specificity is high, its sensitivity is poor.
    • Suspicion for other chest injuries warrants CT scans.
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Other Tests

  • Obtain an ECG in all patients with significant blunt injury to chest. Findings indicative of cardiac contusion include dysrhythmia, conduction disturbances, or ST-segment changes consistent with myocardial injury.
  • Perform cardiac monitoring as workup proceeds until making a disposition decision for the patient.
  • Obtain pulse oximetry on all patients during their evaluation.
  • Do not routinely consider echocardiography in patients with isolated sternal injury. Studies have shown that up to 25% of patients with sternal fracture have small pericardial effusions, yet, in the absence of hemodynamic compromise, this requires no further intervention.
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Procedures

  • No procedures are indicated in patients with isolated sternal fracture, yet consider interventions for associated injuries.
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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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