From the Guidelines
Management of a sternal fracture primarily involves pain control, supportive care, and monitoring for complications, with a focus on symptom control while the bone heals naturally, as most sternal fractures heal within 6-12 weeks without surgical intervention 1.
Key Considerations
- Initial treatment includes pain management with acetaminophen (1000 mg every 6 hours) and NSAIDs like ibuprofen (400-600 mg every 6 hours) for mild to moderate pain.
- For severe pain, short-term opioids such as oxycodone (5-10 mg every 4-6 hours) may be necessary for the first few days.
- Rest is essential, but early mobilization within pain limits should be encouraged to prevent complications like pneumonia.
- Deep breathing exercises should be performed hourly while awake to maintain lung function.
Monitoring and Follow-up
- Patients should be monitored for potential complications including respiratory compromise, cardiac contusion, and mediastinal injuries.
- Follow-up imaging at 6-8 weeks may be warranted to assess healing.
- ECG monitoring and troponin assessment are crucial in evaluating cardiac injury in the setting of blunt trauma, especially in patients with suspected sternal fractures 1.
Surgical Intervention
- Surgery is rarely needed unless there is significant displacement (>1 cm), instability, or associated injuries.
- The use of CT chest without IV contrast is of paramount importance in patients with prior chest surgery or retained metal fragments for accurate diagnosis of cardiac trauma and concomitant vascular injuries 1.
Additional Considerations
- A multidisciplinary approach to care, including orthogeriatric and multidisciplinary teams, may be beneficial in managing patients with sternal fractures, especially in the elderly or those with comorbidities 1.
- Appropriate pain management, fluid management, and early surgery within 48 hours of injury can improve outcomes in patients with fragility fractures, which may be relevant to some patients with sternal fractures 1.
From the Research
Management of Sternal Fractures
- Sternal fractures are predominantly associated with deceleration injuries and blunt anterior chest trauma, and must be carefully evaluated by monitoring of vital parameters and excluding concomitant injuries 2
- Routine admission of patients with isolated sternal fractures for observation is often unnecessary, and an evidence-based judgment regarding the need for hospitalization should be made 2
Treatment Options
- Most (> 95%) sternal fractures are treated conservatively, with surgical fixation indicated in case of fracture instability, displacement, or non-union 3
- Treatment outcomes have shown that all patients display sternal healing, and 98% report pain relief, with treatment complications occurring in 2% of patients 3
Diagnostic Procedures
- Initial electrocardiogram (ECG) and follow-up ECG or equivalent monitoring 6 hours after trauma are recommended for diagnosing myocardial contusion in cases of sternal fracture 4
- Serum troponin I administered 4 to 8 hours after chest trauma is also recommended as an effective means of detecting substantial arrhythmia secondary to myocardial contusion 4
- Emergency physicians should increase their use of ECG in initial or follow-up diagnosis for trauma patients presenting with sternal fracture to detect myocardial contusion and arrhythmia, and consider using troponin in conjunction with ECG to identify patients at risk of complications secondary to myocardial contusion 4