Sternal Fracture Clinical Presentation

Updated: Jul 12, 2017
  • Author: Scott Felten, MD, FACEP; Chief Editor: Trevor John Mills, MD, MPH  more...
  • Print
Presentation

History

In most cases of sternal fracture, consider the diagnosis based on the mechanism of injury. Direct trauma is the most common cause of injury due to mechanisms such as motor vehicle accidents, sports, and falls. Hyperflexion injuries can lead to sternal fractures, often in association with spinal column injuries. [1, 2, 3]

The symptoms in a patient with spontaneous insufficiency or stress fracture create a greater diagnostic challenge unless the diagnosis is considered carefully, because the symptoms often resemble other serious conditions. These fractures tend to occur in the elderly population, especially in postmenopausal women.

Almost all patients complain of localized sternal pain. Pain may be more diffuse in patients with insufficiency fractures and may lead to a more extensive differential diagnosis for chest pain in an older population.

Dyspnea is present in 15-20% of these patients and may indicate associated cardiopulmonary contusion.

Palpitations may be noted only if dysrhythmia occurs, which is unusual in isolated sternal injury without associated cardiac contusion.

Next:

Physical

Carefully assess for signs of other potentially associated injuries in addition to sternal fracture. These may include rib fractures, flail chest, pneumothorax, hemothorax, pulmonary contusion, blunt cardiac injury (manifested by dysrhythmias or murmurs), pericardial tamponade, or vascular injury, as well as head, neck, abdominal, or extremity trauma.

Pain usually is localized over the fracture site and readily reproducible, though patients with insufficiency fractures may have more diffuse pain. Crepitation or displacement is not often palpable unless the sternum is disrupted completely with significant instability of the fragments.

Only 40-55% of patients have overlying soft-tissue edema or ecchymosis. Patients with insufficiency fractures usually exhibit an exaggerated dorsal kyphosis.

Previous
Next:

Causes

With increased use of seat belts and shoulder restraints, the incidence of sternal fracture has increased, but overall severity of injuries has decreased. Presumably, incidence has increased because all of the deceleration forces are concentrated into a nonelastic 2-inch strap that transmits this force directly to the sternum. [15]

Effects of airbags on incidence of sternal fractures are not fully known, though literature suggests a decreased incidence when these are deployed.

Previous