Sternal Fractures
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The literature supports minimal work up for these types of injuries.  If
it is an isolated injury, the cardio-respiratory exam is normal and CXR
and ECG are normal they may be safely discharged home (1,2,3,4,5).  Of course
a high speed deceleration injury may always cause aortic disruption and,
in some places, TEE is recommended even in patients with normal
mediastinum on CXR.  Sternal fractures, however, need not result from
significant deceleration forces and, in some cases are spontaneous or
occur with minimal trauma especially in patients who are osteoporotic.

Other than a search for mediatinal injuries the presence of a sternal
fracture has a high correlation with concomitant compression fractures of
the thoracic and lumbar spine.


H. Louzon MD


(1)


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

We have reviewed 162 consecutive cases of sternal fracture admitted to the
Leicester Royal Infirmary over a 10 year period. There were no incidences of
cardiogenic shock or arrhythmia developing in patients who had sustained an
isolated sternal fracture, irrespective of the aetiology. There were three
deaths, three ITU admissions and one arrhythmia, all occurring in patients
with severe thoracic injuries, or other associated injury. Our series
confirms the observations of other authors, that patients with isolated
sternal fractures, especially those sustained by car occupants wearing
seatbelts, do not develop myocardial pump failure or arrhythmias as a late
or occult phenomenon and can often be discharged home if there is no
clinical evidence of cardiac failure and a 12-lead ECG is normal.

(2)


Hocker K, Renner J
[Sternum fracture--description of this injury based on 100 patient follow-up
studies and review of the literature]
Unfallchirurg 1994 May;97(5):256-62

One hundred patients with sternal fractures were investigated in order to
demonstrate the incidence of complicating cardial, pulmonary and spinal
injuries. Isolated sternal fracture was found in 73/100 patients. In the
majority of cases (68/100) traffic accidents were causative; in 10% an
accompanying injury of the spine was found. No patient presented
electrocardiographic or clinical signs of myocardial contusion, so that no
specific therapy or further investigations by myocardial scintigraphy,
two-dimensional echocardiography or biventricular radionuclide
angiocardiography was necessary. In our group of patients with isolated
sternal fractures, no pathologic results were found on ECG examination or
anteroposterior chest radiograph; in the absence of other significant
injuries, hospital admission is not indicated.

(3)


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

STUDY OBJECTIVE: To look at the hospital course and the outcome of patients
with an isolated sternal fracture. DESIGN: Retrospective analysis of
hospital records. SETTING: A large urban Level I trauma center. TYPE OF
PARTICIPANT: Blunt trauma patients with an isolated sternal fracture.
Patients with other chest radiograph abnormalities were excluded, as were
those with abnormal admission ECGs. MEASUREMENTS AND MAIN RESULTS:
Thirty-one patients with an isolated sternal fracture were identified. No
patient developed new ECG changes or arrhythmias during the hospital stay.
Cardiac enzymes were elevated in one patient (3.2%). No patient had any
adverse cardiopulmonary outcome attributable to the sternal fracture.
CONCLUSION: 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.


(4)


Heyes FL, Vincent R
Sternal fracture: what investigations are indicated?
Injury 1993 Feb;24(2):113-5

A retrospective study of 55 patients with sternal fractures is presented in
an attempt to determine which investigations are predictive of
complications. We conclude that isolated sternal fractures, in the absence
of clinical evidence of cardiac or respiratory complications, and with a
normal electrocardiogram and postero-anterior chest radiograph, require no
further investigation.

(5)


Jackson M, Walker WS
Isolated sternal fracture: a benign injury? [see comments]
Injury 1992;23(8):535-6

Since seat belt legislation was introduced in this country in 1983, we have
seen an increasing number of patients admitted to our unit for observation
following seat belt related sternal fractures. In order to determine the
value of routine admission of patients with isolated sternal fracture we
have reviewed a series of 104 consecutive patients admitted between February
1983 and February 1990 with this injury. Of these, 90 were sustained in road
accidents, 79 of which were as a consequence of seat belt use. The average
age of these patients was 54.5 years (range 11-85 years) with an average
duration of hospital stay of 2.9 nights. No serious complications were
observed. These findings suggest that there may be no need to admit these
patients solely for observation if their initial clinical condition is
satisfactory and there are no abnormalities identified by an anteroposterior
chest radiograph and electrocardiography.