Management of Non-Displaced Sternal Fractures
Non-displaced sternal fractures should be managed conservatively with adequate pain control, as 90-95% of these simple fractures heal spontaneously without surgical intervention. 1
Conservative Management Approach
Initial Assessment and Monitoring
- Exclude concomitant injuries through careful evaluation, including cardiac monitoring (troponin-T and myoglobin levels), assessment for rib fractures, pulmonary contusions, and intra-abdominal injuries 1, 2
- Obtain chest radiographs and ECG as part of comprehensive evaluation 3, 2
- Most isolated, non-displaced sternal fractures do not require routine hospital admission for observation alone 3
Pain Management
- Provide multimodal analgesia as the cornerstone of conservative treatment, which may include oral analgesics and activity modification 4, 1
- Adequate pain relief enables respiratory function and prevents pulmonary complications 1
- Short-term pain relief is typically sufficient for isolated sternal fractures 2
Activity Modification
- Recommend activity modification and bracing during the healing period 4
- Most patients can gradually return to normal activities as pain improves 5
When Surgery Is NOT Indicated
For non-displaced fractures specifically, surgical intervention is rarely necessary and should be reserved for specific complications 1, 2. The vast majority (90-95%) of non-displaced, simple sternal fractures heal without operative management 1.
Red Flags Requiring Surgical Consideration
While your question addresses non-displaced fractures (which are managed conservatively), be aware that surgery becomes indicated if:
- Severe, intractable pain unresponsive to conservative measures develops 1, 5
- Respiratory failure or mechanical ventilation dependency occurs 1, 6
- Significant chest wall deformity or instability develops 1
- Fracture displacement occurs during healing 1
Common Pitfalls to Avoid
- Do not routinely admit patients with isolated, non-displaced sternal fractures for observation alone—this is often unnecessary 3
- Do not miss associated injuries: Complicated sternal fractures (with concomitant injuries) occur in 98.8% versus isolated fractures in only 1.2% of cases 2
- Monitor for cardiac injury: Elevated troponin-T and myoglobin levels indicate more serious trauma requiring closer observation 1
- Assess for rib fractures and intra-abdominal injuries, which are commonly associated and may require additional management 1, 2