Sternum insufficiency fracture presenting as acute chest pain: a case report and review of the literature

Abstract

The spine, pelvic bones and long bones of the lower extremities are common sites for insufficiency fractures. Cases of sternum insufficiency fractures have been rarely reported in an elderly patient. Insufficiency fracture tends to occur in bones with decreased mechanical strength. It tends to occur in elderly patients, especially in postmenopausal women, with underlying diseases. We describe a case of sternum insufficiency fracture in a patient with rheumatoid arthritis and systemic lupus erythematosus on long-term corticosteroid therapy diagnosed in an emergency setting. Sternum insufficiency fracture is a rare cause of chest pain. This case serves to remind the emergency physician to remain vigilant for other noncardiac and nontraumatic causes of chest pain. If diagnosed accurately, these patients can be discharged and treated as outpatients.

Atypical Fracture of the Sternum After Long-Term Alendronate Plus Cholecalciferol Treatment: A Case Report

“…In reviewing the literature, we found only three cases of patients with atraumatic fracture of the sternum. These patients presented well-established risk factors for this type of fracture and did not have a history of bisphosphonate therapy [ 4 – 6 ].…”

Atraumatic sternum fracture

“…This can partly be explained by Fowlers flexion—compression theory, where fractures occur secondary to bending and compression stresses from the thoracic kyphotic deformity with multiple osteoporotic thoracal vertebral compression fractures. The deforming stress on the sternum, combined with the loss of elasticity associated with the ossification of the costal cartilages in elderly patients increases the risk of sternal fracture, and these bones may not even have the elastic strength to withstand minimal stress from activities of daily living 6 7 13 14. Sternum insufficiency fractures also occur without thoracic kyphosis as emphasised by Chen et al 11…”

Insufficiency Fracture of the Sternum Simulating Myocardial Infarction: Case Report and Review of the Literature

“…The spine, pelvis, and lower extremities are commonly affected by these fractures, whereas insufficiency fracture of the sternum is rare. Approximately 40 cases with sternal insufficiency fractures have been reported in the literature (Itani et al 1982;Cooper 1988;Chen et al 1990;Sapherson and Mitchell 1990;Schapia et al 1995;Benbouazza et al 2003;Min and Sung 2003;Soubrier et al 2003;Ragucci and Vainrib 2005;Lin and Ponampalam 2006) and the fracture was classified as either the buckling type or nonbuckling type as suggested by Chen et al (1990). A buckling sternal fracture was defined as a sternal deformity in which the upper portion of the sternum was located posterior to the lower portion, and in which there was no tion.…”