Initial Management of Non-Displaced Sternal Fracture
Non-displaced sternal fractures should be managed conservatively with adequate pain control, short-term observation to exclude cardiac and pulmonary injuries, and early mobilization without routine hospital admission.
Immediate Assessment and Exclusion of Associated Injuries
The priority in managing sternal fractures is identifying life-threatening associated injuries rather than the fracture itself, as mortality is typically related to concomitant injuries rather than the sternal fracture 1.
- Cardiac monitoring and evaluation is essential initially to exclude myocardial contusion, arrhythmias, and other cardiac injuries 2, 3
- Pulmonary assessment must be performed to identify lung contusions, pneumothorax, or respiratory compromise 1, 3
- Imaging beyond plain radiographs (CT chest) should be obtained if there is concern for intrathoracic injuries, as these are present in 98.8% of sternal fracture cases 1
- Associated injuries to evaluate include extremity fractures, brain injury, and intraabdominal injuries, which are the most common complications 1
Pain Management Protocol
Adequate analgesia is paramount and should be initiated immediately to prevent respiratory compromise from pain-related splinting 4, 2.
- Regular paracetamol (acetaminophen) should be prescribed routinely as first-line analgesia 5
- NSAIDs can be added for additional pain control, but should be avoided in patients with renal dysfunction 5
- Opioids may be used cautiously for severe pain in the acute phase, with appropriate dose adjustments in renal impairment 5
- Multimodal analgesia is preferred to minimize opioid requirements while maintaining adequate pain control 4
Conservative Management Approach
For isolated, non-displaced sternal fractures without complications, conservative management is sufficient 2, 1.
- Short-term pain relief (typically 4 days or less of hospital observation) is adequate for uncomplicated cases 3
- Sternal bracing may be considered to provide immobilization, facilitate early ambulation, and improve patient comfort, though it is not mandatory for non-displaced fractures 3
- Early mobilization should be encouraged as tolerated once life-threatening injuries are excluded 4
- Routine hospital admission is unnecessary for isolated sternal fractures once cardiac and pulmonary complications are excluded 2
Indications That Would Change Management
While non-displaced fractures are managed conservatively, be aware of scenarios requiring surgical consideration 6, 7:
- Severe refractory pain unresponsive to conservative measures 6, 1
- Respiratory failure or mechanical ventilation dependency 6
- Significant cosmetic deformity 6
- Sternal instability on examination 7
- Cardiac compression 6
Follow-Up
- Clinical reassessment within 1-2 weeks to ensure adequate pain control and functional recovery 2
- Serial radiographs are generally not necessary for non-displaced fractures unless clinical deterioration occurs 5
- Most patients recover fully with conservative management alone 2, 3
Critical Pitfall: The most common error is over-treating isolated, non-displaced sternal fractures with prolonged hospitalization when the real danger lies in missing associated life-threatening injuries during the initial evaluation 2, 1.