Sternal Fracture

Sternal Fracture

No Results

No Results

processing….

Sternal fractures are predominantly associated with deceleration injuries and blunt anterior chest trauma (incidence of 3-6.8% in motor vehicle collisions). Consider the diagnosis on the basis of the mechanism of injury. Direct trauma is the most common cause of injury (eg, motor vehicle accidents, sports, and falls). [1, 2, 3]

Fractures usually occur at the body or the manubrium. Lateral chest radiograph is considered the gold standard for making the diagnosis, because fracture and displacement or dislocation occurs in the sagittal plane. An anteroposterior chest radiograph can be helpful in detecting other injuries, such as rib fracture, pulmonary contusion, hemothorax, and pneumothorax. Ultrasonography demonstrates sternal fractures with as much sensitivity as plain radiography and can accurately identify related hematomas and pleural effusions, but it is ltrasound is not accurate in identifying the degree of displacement of sternal fractures. [4, 5, 6, 7]

Most sternal fractures are caused by blunt anterior chest trauma. Insufficiency fractures caused by abnormally decreased bone density or weakened bone can occur spontaneously in patients with osteoporosis or osteopenia (particularly in older persons, especially women), those on long-term steroid therapy, or those with severe thoracic kyphosis. Cardiopulmonary resuscitation commonly causes rib and sternal fractures.

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.

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.

 

 

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, especially women), 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.

Fractures usually occur at the body or the manubrium. In one study of 79  patients with sternal fracture, 13 (16.5%) had a fracture of the manubrium, 10 caused by seat-belt injury. In 3 cases stabilization was performed, and follow-up showed sufficient consolidation without complications. [8]

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

Motor vehicle collisions account for 60-90% of sternal fractures. [9] Most of these are in older vehicles in which a seat belt is used but no airbag deploys. [10] 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.

The mortality rate from isolated sternal fracture is extremely low. Mortality associated with sternal fracture is 0.7%. 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.

Sternal fractures are slightly more common in females than in males, possibly because of shoulder restraint positioning; however, the difference is small. 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. [11, 12, 13, 14]

Because of the lack of substantial change in size or shape of the sternum between ages 30 and 100 years, the increased incidence of sternal fracture in the elderly may be the result of cortical thickness or bone mineral density changes in the sternum, as opposed to changes in morphology. [11]

The prognosis is excellent for isolated sternal fractures. Most patients recover completely over a period of several weeks.

In rare cases of nonunion and chronic sternal pain, surgical fixation can be considered.

During pregnancy, shield the abdomen and pelvis with a lead apron prior to obtaining required chest radiographs. NSAIDs for analgesia are contraindicated outside the first trimester, though several category B opiate combinations exist for pain management.

In older people, provide adequate analgesia; however, consider that a patient’s baseline level of independent function may be compromised by adequate analgesics. Consider appropriate arrangements for assistance. Consideration for admission is supported by current trauma literature.

Although no evidence specifically links sternal fractures to abuse in this age group, [12] they are unusual injuries in children. Just like long bone fractures and rib fractures, sternal fractures should heighten the suspicion of child abuse. Sternal fractures are also more difficult to recognize on radiographs in the pediatric population and should be suspected if deformity, crepitus and significant pain are present.

Schulz-Drost S, Krinner S, Langenbach A, Oppel P, Lefering R, Taylor D, et al. Concomitant Sternal Fracture in Flail Chest: An Analysis of 21,741 Polytrauma Patients from the TraumaRegister DGU®. Thorac Cardiovasc Surg. 2017 Feb 10. [Medline].

Morgenstern M, von Rüden C, Callsen H, Friederichs J, Hungerer S, Bühren V, et al. The unstable thoracic cage injury: The concomitant sternal fracture indicates a severe thoracic spine fracture. Injury. 2016 Nov. 47 (11):2465-2472. [Medline].

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. 2016 Apr. 40 (4):791-8. [Medline].

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

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

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].

Racine S, Émond M, Audette-Côté JS, Le Sage N, Guimont C, Moore L, et al. Delayed complications and functional outcome of isolated sternal fracture after emergency department discharge: a prospective, multicentre cohort study. CJEM. 2016 Sep. 18 (5):349-57. [Medline].

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].

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].

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].

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].

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].

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

Fichtel I, Fernandez FF, Wirth T. [Sternal fracture in growing children : A rare and often overlooked fracture? Documentation of four cases]. Unfallchirurg. 2016 Jul. 119 (7):570-4. [Medline].

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].

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:

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

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:

Terry NL, Watts JR Jr, Sonavane SK, Beasley TM, Munden R, Nath PH, et al. Improved identification of sternal injuries with multidetector computed tomography (MDCT): sagittal reconstructions. Clin Imaging. 2016 Jul-Aug. 40 (4):739-44. [Medline].

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].

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].

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

Raza I, Narayanan M, Venkataraju A, Ciocarlan A. Bilateral Subpectoral Interfascial Plane Catheters for Analgesia for Sternal Fractures: A Case Report. Reg Anesth Pain Med. 2016 Sep-Oct. 41 (5):607-9. [Medline].

Thomas KP, Sainudeen S, Jose S, Nadhari MY, Macaire PB. Ultrasound-Guided Parasternal Block Allows Optimal Pain Relief and Ventilation Improvement After a Sternal Fracture. Pain Ther. 2016 Jun. 5 (1):115-22. [Medline].

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].

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

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].

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].

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

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].

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].

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].

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].

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].

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].

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

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

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

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].

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

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.

Mark S Slabinski, MD, FACEP, FAAEM Vice President, USACS Central

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.

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.

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.

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.

Sternal Fracture

Research & References of Sternal Fracture|A&C Accounting And Tax Services
Source

48 thoughts on “Sternal Fracture

  1. Pingback: viagra 100mg
  2. Pingback: ed drugs
  3. Pingback: otc ed pills
  4. Pingback: sale cialis
  5. Pingback: rx pharmacy
  6. Pingback: rx pharmacy
  7. Pingback: cialis mastercard
  8. Pingback: cialis visa
  9. Pingback: buy levitra
  10. Pingback: vardenafil generic
  11. Pingback: casinos
  12. Pingback: sildenafil 20
  13. Pingback: cialis 20 mg
  14. Pingback: loan online
  15. Pingback: online loans
  16. Pingback: online loans
  17. Pingback: viagra cost
  18. Pingback: cialis 5 mg
  19. Pingback: new cialis
  20. Pingback: cialis to buy
  21. Pingback: 20 cialis
  22. Pingback: generic for cialis
  23. Pingback: casino match bonus
  24. Pingback: viagra prices
  25. Pingback: cheap viagra
  26. Pingback: buy viagra uk
  27. Pingback: casino slot games
  28. Pingback: generic viagra
  29. Pingback: cheap viagra
  30. Pingback: viagra
  31. Pingback: cialis pills
  32. Pingback: viagra for women

Leave a Reply