Sternal fracture: Difference between revisions
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==Background== | ==Background== | ||
*Fracture is more likely in restrained passengers than unrestrained passengers | [[File:Sobo 1909 31.png|thumb|Anatomy of the sternum.]] | ||
*Fracture is more likely in restrained passengers than unrestrained passengers (high-energy trauma) | |||
*Isolated sternal fracture is relatively benign | *Isolated sternal fracture is relatively benign | ||
**Low mortality (<1%) | **Low mortality (<1%) | ||
**Low intrathoracic morbidity | **Low intrathoracic morbidity | ||
* | *Sternal body fracture most common | ||
* | ===Associated Injuries=== | ||
*No association between sternal fracture and aortic rupture | *[[Rib fracture]] | ||
*[[Pulmonary contusion]] | |||
*[[Myocardial contusion]] (1.5%) | |||
*<u>No</u> association between sternal fracture and aortic rupture | |||
==Clinical Features== | ==Clinical Features== | ||
| Line 13: | Line 17: | ||
*Point tenderness over sternum | *Point tenderness over sternum | ||
*Ecchymosis, soft tissue swelling | *Ecchymosis, soft tissue swelling | ||
==Differential Diagnosis== | |||
{{Thoracic trauma DDX}} | |||
==Evaluation== | ==Evaluation== | ||
* | [[File:DisplacedSternalFracture.jpg|thumb|A displaced sternal fracture as seen on lateral X-ray.]] | ||
[[File:Sternal fracture CT.jpg|thumb|Comminuted sternal fracture on CT]] | |||
[[File:PMC3259405 13244 2011 72 Fig25 HTML.png|thumb|Axial CT showing sternal fracture with retrosternal haematoma (black arrow). Also aortic injury (white arrows).]] | |||
===Workup=== | |||
*[[CXR]] or CT | |||
===Diagnosis=== | |||
*Most are visible on lateral [[CXR]] | |||
*CT is test of choice if high suspicion | |||
==Management== | ==Management== | ||
*[[ECG]] | *[[ECG]] | ||
*Consider troponin | *Consider [[troponin]] | ||
==Disposition== | ==Disposition== | ||
*Isolated, non-displaced fracture: | *Isolated, non-displaced fracture: | ||
**If pain control achieved and ECG normal ok to discharge home | **If pain control achieved and [[ECG]] normal ok to discharge home | ||
*Displaced fracture or concern for severe pain or respiratory compromise: | *Displaced fracture or concern for severe pain or respiratory compromise: | ||
**Refer for operative fixation | **Refer for operative fixation | ||
Latest revision as of 13:12, 10 April 2021
Background
- Fracture is more likely in restrained passengers than unrestrained passengers (high-energy trauma)
- Isolated sternal fracture is relatively benign
- Low mortality (<1%)
- Low intrathoracic morbidity
- Sternal body fracture most common
Associated Injuries
- Rib fracture
- Pulmonary contusion
- Myocardial contusion (1.5%)
- No association between sternal fracture and aortic rupture
Clinical Features
- Anterior chest pain
- Point tenderness over sternum
- Ecchymosis, soft tissue swelling
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Evaluation
Workup
- CXR or CT
Diagnosis
- Most are visible on lateral CXR
- CT is test of choice if high suspicion
Management
Disposition
- Isolated, non-displaced fracture:
- If pain control achieved and ECG normal ok to discharge home
- Displaced fracture or concern for severe pain or respiratory compromise:
- Refer for operative fixation