From the Guidelines
For a patient with a sternal fracture resulting from a motor vehicle collision (MVC), immediate medical attention is crucial, and management should prioritize pain control, assessment for associated injuries, and monitoring for potential complications, as outlined in the 2023 WSES guidelines 1. The patient's airway, breathing, and circulation should be stabilized, and pain management should be initiated with intravenous acetaminophen every 6 hours as the first line of treatment, considering a multimodal analgesic approach 1. Some key points to consider in the management of such a patient include:
- Assessing the severity of the fracture and ruling out associated injuries through chest imaging, including CT scans
- Implementing cardiac monitoring and troponin levels to detect myocardial injury
- Encouraging deep breathing exercises to prevent atelectasis and pneumonia
- Considering the use of NSAIDs, gabapentinoids, and opioids for breakthrough pain, while being mindful of potential adverse events and pharmacological interactions 1
- Evaluating the need for thrombo-prophylaxis with LMWH or UFH, taking into account the patient's renal function, weight, and bleeding risk 1 The management of a patient with a sternal fracture from an MVC should focus on conservative management with pain control and limited activity for 6-8 weeks, with surgery rarely needed unless there is significant displacement or instability, and careful consideration of the patient's overall clinical condition and potential for complications 1.
From the Research
Management of Sternal Fractures
The management of sternal fractures resulting from a motor vehicle collision (MVC) can be conservative or surgical, depending on the severity of the fracture and associated injuries.
- Isolated sternal fractures are commonly benign injuries that can be managed conservatively in an outpatient setting 2.
- Patients with sternal fractures should be carefully screened for possible associated injuries, such as cardiac contusion or thoracic 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.
- Patients with a sternal fracture and normal cardiac enzyme levels and electrocardiogram may be safely discharged from the emergency department, provided there are no other major injuries 4.
- Fixation may be performed on patients with bony deformity, intractable pain, and thoracic instability 3.
Diagnostic Evaluation
The diagnosis of sternal fractures has seen a recent rise, largely due to the increased access to computed tomography (CT) scan 2.
- A lateral x-ray of the sternum is useful in fracture evaluation 3.
- CT scan, ECG, serum CPK, and an echocardiogram may be used to evaluate associated trauma 3.
- Two-dimensional echocardiography may be performed to reveal pericardial effusion 5.
Associated Injuries
Sternal fractures can be associated with other injuries, such as: