Sternal fractures

Abstract

Sternal fractures are relatively common and range from simple unicortical cracks to displaced fractures associated with life threatening injuries. This paper describes the relevant anatomy, biomechanics, mechanism of injury, clinical presentation, investigation, treatment and complications and also includes associated and concomitant injuries. A management flow chart including criteria for discharge from the emergency department is presented.

Radiologic Imaging of Chest Injuries

“…Sternal fractures in children do occur but are uncommon due to the elasticity of the chest. When children fracture their sternum, the injury mechanisms are similar to those observed in adults (Raghunathan and Porter 2011 ).…”

“…This injury mechanism can occur during sports trauma, especially in contact sports and high-energy sports (motor racing), but can also result from strong muscular contraction as seen in, for example, gymnastics and weightlifting (Raghunathan and Porter 2011 ). Other thoracic structures as the ribs, vertebrae or internal organs can be injured, sometimes resulting in vertebral and/or rib fractures or intrathoracic injury (Raghunathan and Porter 2011 ).…”

“…If the sternum is fractured due to such a highenergy accident, it is often associated with cardiac (life-threatening commotio cordis) or pulmonary injury as well (Mulder et al 2012 ). Next to a fracture resulting from direct force to the chest, the sternum can fracture when extreme fl exionrotation or fl exion-compression of the cervicothoracic spine takes place or when falling on the shoulder or head results in compression of the thorax (Raghunathan and Porter 2011 ). This injury mechanism can occur during sports trauma, especially in contact sports and high-energy sports (motor racing), but can also result from strong muscular contraction as seen in, for example, gymnastics and weightlifting (Raghunathan and Porter 2011 ).…”

“…Next to a fracture resulting from direct force to the chest, the sternum can fracture when extreme fl exionrotation or fl exion-compression of the cervicothoracic spine takes place or when falling on the shoulder or head results in compression of the thorax (Raghunathan and Porter 2011 ). This injury mechanism can occur during sports trauma, especially in contact sports and high-energy sports (motor racing), but can also result from strong muscular contraction as seen in, for example, gymnastics and weightlifting (Raghunathan and Porter 2011 ). Other thoracic structures as the ribs, vertebrae or internal organs can be injured, sometimes resulting in vertebral and/or rib fractures or intrathoracic injury (Raghunathan and Porter 2011 ).…”

“…For imaging of sternal fractures, lateral and AP radiographs are taken fi rst (Raghunathan and Porter 2011 ). Other authors prefer PA radiographs.…”