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