Editing Sternal fractures


Historically called 'steering wheel injury'

== Associations ==

* Only 25% are isolated injuries
* Only 2% are associated with blunt cardiac injury or great vessel injury
* Around 50% also have rib fractures

== Presentation ==

* Typically transverse fractures in the upper and mid portions of the body of the sternum
* Look for point tenderness, swelling and deformity

== Workup ==

* Should generally have angiogram and troponins and ECG
* Consider echo - however 'there is clear evidence that TTE and troponins in the assessment of isolated sternal fractures, particularly with normal admission ECG and CXR, may not be indicated' according to Shields
** However need to carefully look for cardiac injury on CT, ECG, and probably do a troponin on admission
* MRI can be useful specifically to identify secondary osteomyelitis or acute mediastinitis, and in evaluating SCJ involvement

== Management ==

* Analgaesia
* Pulmonary hygiene (similar to rib fractures)
* Indications for surgery (Shields)
** Displaced sternal fractures refractory to medical management
** Severely displaced fractures
** Severe pain
** Sternal instability compromising pulmonary or cardiac function
** Non-union of the sternum due to pseudarthrosis sterni
* Surgery
** Usually plating or wiring through a midline incision
** Only a small proportion of patients (2% in one study) underwent surgery

== Natural history ==

* More serious complications are generally due to associated injuries

[[Category:Trauma]]
[[Category:Thoracics]]