From the Guidelines
Sternal fractures can have significant implications, including prolonged mechanical ventilation, pneumonia, and increased morbidity, emphasizing the importance of early surgical stabilization of rib fractures (SSRF) within 48-72 hours from the traumatic injury, as supported by recent studies 1. The optimal timing for SSRF is crucial, with benefits including minimizing unfavorable outcomes and reducing technical complexity of the surgical procedure 1. Key considerations for managing sternal fractures include:
- Pain management with medications like acetaminophen or NSAIDs for 1-2 weeks as needed
- Rest and limited movement of the upper body during the initial healing phase
- Deep breathing exercises to prevent respiratory complications
- Ice packs to reduce pain and swelling
- Medical attention to rule out associated injuries to the heart, lungs, or blood vessels Recent studies have shown that early SSRF, defined as occurring within 72 hours of the initial injury, can decrease the overall hospital and ICU length of stay, duration of mechanical ventilation, and hospitalization costs 1. Additionally, early SSRF has been associated with decreased levels of inflammatory cytokine and infection markers, and reduced need for prolonged mechanical ventilation 1. It is essential to note that the decision for late surgery (i.e., 7-14 days from injury) should be made on a case-by-case basis, as there are no data to suggest that it confers a benefit over non-operative management (NOM) 1. In cases of severe chest wall injury, early or medium-term surgery may not be possible, and other injuries may take priority 1. Overall, the management of sternal fractures requires careful consideration of the optimal timing for SSRF, as well as the individual patient's needs and associated injuries.
From the Research
Implications of Sternal Fracture
The implications of a sternal fracture can be significant, with potential effects on a patient's quality of life and functional ability. Some of the key implications include:
- Intractable chest wall pain: Sternal fractures can cause severe and persistent pain, which can impact a patient's ability to perform daily activities 2, 3.
- Limited range of motion: Sternal fractures can also limit a patient's range of motion, particularly in the upper extremities, which can further impact daily functioning 3.
- Respiratory compromise: In some cases, sternal fractures can lead to respiratory compromise, particularly if the fracture is severe or if there are associated injuries 4, 5.
- Increased risk of complications: Sternal fractures can also increase the risk of complications, such as pneumonia or other respiratory infections, particularly if the patient is elderly or has underlying health conditions 4.
Treatment Options
Treatment options for sternal fractures can vary depending on the severity of the fracture and the patient's overall health. Some of the key treatment options include:
- Conservative management: In some cases, sternal fractures can be managed conservatively with pain control and monitoring for complications 2, 4.
- Surgical fixation: In more severe cases, surgical fixation may be necessary to stabilize the fracture and improve outcomes 2, 3, 6, 5.
- Minimally invasive plate osteosynthesis: This is a newer treatment option that involves using a minimally invasive approach to stabilize the fracture with a plate 6.
Outcomes
The outcomes of sternal fracture treatment can vary depending on the severity of the fracture and the treatment approach. Some of the key outcomes include:
- Improved pain: Surgical fixation has been shown to improve pain outcomes in patients with sternal fractures 3, 5.
- Improved range of motion: Surgical fixation can also improve range of motion in patients with sternal fractures 3.
- Decreased opioid use: Surgical fixation has been shown to decrease opioid use in patients with sternal fractures 3, 5.
- Improved respiratory function: Surgical fixation can also improve respiratory function in patients with sternal fractures 5.