Diagnostic and therapeutic options for traumatic sternal fractures

BACKGROUND: Sternal fractures are uncommon injuries observed in the direct impact of the sternum against the steering wheel in car accidents with the likelihood of associated thoracic injuries. OBJECTIVES: To present our experience in the management of blunt sternal fractures. LOCATION: Hospital de Urgencias de Cordoba. MATERIALS AND METHODS: Patients with blunt sternal fracture were included over a one year period. After an anterior chest x-ray suggested a clinical problem, lateral x-ray of the sternum was performed for the fracture diagnosis. CT scan, ECG, serum CPK and an echocardiogram were used to evaluate the associated trauma. The indications for fixation were bony deformity, intractable pain and thoracic instability. RESULTS: Of eight patients with sternal fractures, 5 were caused by road accidents and the others by a direct blow in the chest. Five patients suffered associated injuries. One patient presented cardiac contusion but did not require treatment. Fixation was performed on 4 patients. No surgical complications were observed. CONCLUSIONS: Sternal fracture should be suspected in patients with anterior chest trauma from road accidents. A lateral x-ray of the sternum is useful in fracture evaluation. Possible associated thoracic Injuries need to be necessarily evaluated. Osteosintesis should be performed on patients with bony deformity and severe pain, while for stable, not displaced or conminuted fractures, pain relief should be performed.