Treatment of Non-Displaced Sternal Fracture in a 26-Year-Old Male
Conservative management with analgesics and activity modification is the appropriate treatment for a non-displaced sternal fracture in this young patient, as the vast majority (90-95%) of non-displaced sternal fractures heal spontaneously without surgical intervention.
Primary Treatment Approach
Non-operative management is indicated for non-displaced sternal fractures, which represents the standard of care for most traumatic sternal injuries 1, 2. This approach includes:
- Pain control with analgesics as the cornerstone of conservative treatment 3
- Activity modification to reduce mechanical stress on the fracture site 3
- Rest and observation allowing spontaneous healing to occur 1
The evidence strongly supports this conservative approach, as 90-95% of sternal fractures are non-displaced, simple fractures that heal without intervention 1. A systematic review of 191 patients demonstrated that all patients achieved sternal healing with appropriate treatment 2.
When Surgery Would Be Indicated (Not Applicable Here)
Surgical fixation is reserved for specific indications that do not apply to this patient 1, 2:
- Fracture instability or significant displacement requiring reduction 1, 2
- Intractable chest wall pain unresponsive to conservative measures 4, 1
- Bony crepitus from sternal instability 4
- Severe chest wall deformity or anterior flail chest 4, 1
- Chronic nonunion with debilitating symptoms 5
Only 3.8-5% of sternal fractures require surgical intervention 1, 2, and this 26-year-old with a non-displaced fracture does not meet these criteria.
Critical Assessment Requirements
Evaluate for associated injuries that commonly accompany sternal fractures 1:
- Cardiac evaluation: Check troponin-T and myoglobin levels, as elevated markers correlate with more severe sternal injuries and associated cardiac trauma 1
- Rib fractures: Assess for concomitant rib injuries which occur more frequently with complicated sternal fractures 1
- Intra-abdominal injuries: Screen for abdominal trauma, particularly with flexion mechanisms 1
- Chest imaging: Ensure no associated thoracic injuries requiring intervention 1
Expected Outcomes
With conservative management, this patient should expect 2, 6:
- Complete sternal healing (100% healing rate in systematic review) 2
- Pain relief (98% of patients achieve adequate pain control) 2
- Return to normal activities once pain subsides and fracture stability is confirmed 6
Common Pitfalls to Avoid
Do not rush to surgical intervention in non-displaced fractures, as the complication rate with surgery (2%) must be weighed against the excellent outcomes of conservative treatment 2. Surgery should only be considered if the patient develops intractable pain or fracture displacement during the healing period 4, 1.
Monitor for fracture displacement during the initial healing phase, as some initially non-displaced fractures may become unstable 1. However, this is uncommon and does not warrant prophylactic fixation.