HWN Suggests

Should We Admit All Patients with Sternal Fractures?

Sternal fractures are predominantly associated with deceleration injuries and blunt anterior chest trauma. Sternal trauma must be carefully evaluated by monitoring of vital parameters and it is of paramount importance that concomitant injuries are excluded. Nevertheless, routine admission of patients with isolated sternal fractures for observation is still common in today's practice, which is often unnecessary.

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 Sternal fractures - Break on through to the other side...

We agree with the authors’ conclusion about the incidence of delayed hemothorax in patients with isolated sternal fractures that are discharged home. We are less confident about their conclusions about disability.

Articles of Interest

Cardiac findings of sternal fractures due to thoracic trauma: A five-year retrospective study

Abnormal echocardiography findings were more frequent in patients with sternal fracture on the manubrium and displaced fracture.

Concomitant Sternal Fractures: Harbinger of Worse Pulmonary Complications and Mortality in Patients With Rib Fractures

Concomitant sternal fractures are associated with increased risk for pulmonary morbidity and mortality among patients with rib fractures. However, our findings are limited by a binary definition of sternal fractures, which encompasses heterogeneous injury patterns with likely variable clinical relevance.

Isolated sternal fracture after low-energy trauma in a geriatric patient: a case report

Geriatric patients can present in the ED with a rare sternal fracture even after only a minor chest trauma. Appropriate imaging and an ECG are warranted to exclude life-threatening additional injuries.

Myth of the dangerous sternal fracture

The outcome of patients with an isolated sternal fracture and a normal ECG is very good. Routine admission and cardiac monitoring do not appear to be warranted in this subset of patients with a sternal fracture.

Sternal Fracture

Although they are usually detected using a lateral plain film, sternal fractures are difficult to demonstrate on a 1 view CXR, especially in the trauma setting. The utility of ultrasound then is only understated, as it allows quick and accurate bedside diagnosis. Ultrasound may be used, similarly, in other areas of bony injury to detect fractures as well.

Sternal fractures and their management

Routine hospital admission is therefore unnecessary for all patients with sternal fractures, and is warranted in those with significant associated injuries. Other factors which may justify hospitalization include major co-morbidities, high-impact trauma, severely displaced fractures, inadequate pain control, or insufficient domestic support.

Sternum: Overview, Anatomy, and Function

This flat, elongated bone plays a crucial role not only in providing structural integrity to the thoracic region but also in protecting vital organs such as the heart and lungs.

Traumatic Sternal Fractures can be Safely Treated Conservatively - A 13-Year Retrospective Cohort Study

The clinical relevance of isolated sternal fractures has not been clearly established. Traditionally, sternal fractures are considered harbingers of severe concomitant injuries rather than individual entities requiring specific attention. According to literature, isolated sternal fractures are generally mild injuries and conservative therapy (mostly consisting of analgesia) suffices for most patients.

Resources

Physiopedia

A CT scan is used most commonly to diagnose sternal fractures. But is less sensitive than plain radiography.

StatPearls

Sternal fractures have a reported incidence of 3%-6.8% in motor vehicle collisions as they are most commonly caused by blunt chest trauma. These fractures are frequently evaluated using a lateral chest X-ray or CT scan of the chest.