From the Guidelines
Management of an acute cortical fracture of the anterior border of the sternal manubrium typically involves conservative treatment with pain management and rest. Initial treatment should include analgesics such as acetaminophen (500-1000 mg every 6 hours) or NSAIDs like ibuprofen (400-600 mg every 6-8 hours) for pain control, unless contraindicated, as supported by general medical knowledge. For more severe pain, a short course of opioid analgesics may be considered, such as hydrocodone/acetaminophen 5/325 mg every 4-6 hours for 3-5 days.
Key Considerations
- Activity modification is essential, with avoidance of heavy lifting, pushing, or pulling for 4-6 weeks to allow proper healing.
- Application of ice for 15-20 minutes several times daily for the first 48-72 hours can help reduce pain and swelling.
- Deep breathing exercises should be encouraged to prevent pulmonary complications, performing 10 deep breaths every hour while awake.
- Follow-up imaging at 6-8 weeks is recommended to assess healing, as most sternal manubrium fractures heal well with conservative management due to the area's good blood supply 1.
Surgical Intervention
Surgery is rarely needed unless there is significant displacement, instability, or associated injuries, and the decision for surgical intervention should be made on a case-by-case basis, considering the patient's overall condition and the specifics of the fracture. The patient should be monitored for complications such as delayed union or chronic pain, which may require further evaluation. Although a study from 2002 mentions surgery as a usual treatment for certain types of fractures 1, this is not directly applicable to the management of acute cortical fractures of the sternal manubrium, and more recent evidence supports a conservative approach as the first line of treatment.
From the Research
Management of Acute Cortical Fracture of the Anterior Border of the Sternal Manubrium
The management of an acute cortical fracture of the anterior border of the sternal manubrium can be approached in the following ways:
- Classification of Fractures: Fractures of the manubrium can be classified into three main types: A-type (transverse fracture), B-type (oblique fracture), and C-type (combined, more fragmentary fracture) 2.
- Treatment Options: Treatment options for fractures of the manubrium include conservative management for minimally displaced fractures and surgical stabilization for unstable fractures 2, 3, 4.
- Surgical Stabilization: Surgical stabilization can be achieved through anterior plating using low-profile titanium plates, with the approach and plate positioning depending on the type and location of the fracture 2, 4, 5.
- Indications for Surgical Intervention: Indications for surgical intervention include severely displaced fractures, complex co-morbidities, significant associated injuries, and instability of the upper sternum and shoulder girdle 6, 4.
- Preoperative Planning: Preoperative planning is crucial and may involve a detailed survey of the patient and a three-dimensional reconstructed computed tomography to determine the fracture's morphology and guide surgical approach 5.
- Surgical Technique: The surgical technique for anterior sternal plating involves a midline incision, subperiosteal dissection, reduction of the fracture, depth-limited drilling, and fixation of the plates to prevent injuries to mediastinal organs and vessels 5.