What is the management of sternal fracture?

From the Guidelines

Management of sternal fractures primarily involves pain control, respiratory support, and monitoring for complications, with most uncomplicated cases healing without surgical intervention within 6-12 weeks 1. The initial treatment includes analgesics such as acetaminophen (1000 mg every 6 hours) or NSAIDs like ibuprofen (400-600 mg every 6 hours) for mild pain, progressing to opioids such as oxycodone (5-10 mg every 4-6 hours) for moderate to severe pain. Some key points to consider in the management of sternal fractures include:

• Pain management is crucial to prevent respiratory compromise, as patients with sternal fractures often limit breathing due to pain, potentially leading to atelectasis or pneumonia.
• Patients should be monitored for cardiac contusion with ECG and cardiac enzymes, as the sternum protects vital mediastinal structures.
• Deep breathing exercises and incentive spirometry (10 breaths every hour while awake) are recommended to prevent pulmonary complications.
• Activity modification with avoidance of heavy lifting (>10 pounds) for 6-8 weeks allows for proper healing.
• Surgery is rarely needed but may be considered for severely displaced fractures (>1 cm displacement), flail chest, or persistent pain, as noted in the context of rib fractures and their management 1. Some specific considerations for the management of sternal fractures, based on the most recent evidence, include:
• The use of costal cartilage fractures as potential candidates for surgical fixation, with techniques such as medial fixation to the sternum or the use of plates and wires 1.
• The importance of precise reporting language in describing costal cartilage fractures, including the location and extent of the fracture 1. Follow-up should occur at 2 weeks and 6 weeks post-injury to assess healing progress and adjust pain management as needed, with the prognosis generally good for isolated sternal fractures, and most patients returning to normal activities within 2-3 months.

From the Research

Management of Sternal Fracture

• The management of sternal fractures can be conservative or surgical, depending on the severity of the fracture and associated injuries 2, 3.
• Isolated sternal fractures are commonly benign injuries that can be managed conservatively in an outpatient setting 2.
• Polytrauma patients with sternal fractures should be carefully screened for possible associated injuries 2, 3.
• Surgical stabilization of sternal fractures is feasible and safe, and should be considered in unstable fractures, severe displacement, symptomatic malunion or non-union 2, 4, 5.

Treatment Options

• Sternal bracing appears to offer a rational compromise in the treatment of uncomplicated sternal fractures, providing early pain-free ambulation, satisfactory fracture immobilization, and simplified patient hygienic care 6.
• Sternal fixation has been shown to improve pain and upper extremity range of motion in patients with isolated traumatic sternal fractures 4.
• Operative management of chest wall injuries, including surgical stabilization of sternal fractures, aims to restore respiratory mechanics and mitigate pulmonary complications 5.

Outcomes

• Patients who underwent surgical stabilization of sternal fractures had lower odds of mortality compared to those who underwent non-operative management 5.
• Sternal fixation has been shown to result in improved pain, decreased narcotic requirements, and faster recovery in patients with isolated traumatic sternal fractures 4.
• The role of surgical stabilization of sternal fractures remains unclear, and further study is needed to establish consensus indications 5.