From the Guidelines
All of these injuries—pericardial tamponade, myocardial contusion, and pulmonary contusion—are commonly associated with sternal fractures. Sternal fractures typically result from high-energy blunt trauma to the chest, such as during motor vehicle accidents when the chest impacts the steering wheel. The close anatomical relationship between the sternum and vital thoracic structures explains these associations. Myocardial contusion occurs when the heart is compressed between the sternum and spine during impact, as noted in a study published in the Journal of the American College of Radiology 1. Pulmonary contusion develops from the same mechanism affecting the underlying lung tissue. Pericardial tamponade can result from bleeding into the pericardial sac following injury to the heart or pericardium. These associated injuries contribute significantly to the morbidity and mortality of sternal fractures, which is why patients with sternal fractures require thorough evaluation for these potentially life-threatening complications, including ECG, cardiac enzyme testing, and chest imaging, as recommended by the American College of Radiology 1. Some key points to consider in the evaluation and management of sternal fractures include:
- The use of CT chest without IV contrast to identify hemothorax or hemopericardium and to detect sternal fractures 1
- The importance of ECG monitoring and troponin assessment to evaluate cardiac injury in the setting of blunt trauma 1
- The role of echocardiography in evaluating patients with suspected blunt cardiac trauma presenting with abnormal ECG and elevated cardiac troponin level 1
- The need for thorough evaluation of patients with sternal fractures for associated injuries, including pericardial tamponade, myocardial contusion, and pulmonary contusion.
From the Research
Injuries Associated with Sternal Fractures
- Pericardial tamponade: This condition is characterized by the accumulation of fluid in the pericardial space, leading to impaired cardiac function 2, 3, 4, 5.
- Myocardial contusion: This injury occurs when the heart muscle is bruised, often as a result of blunt trauma to the chest 6.
- Pulmonary contusion: This condition involves bruising of the lung tissue, which can lead to respiratory complications 6.
Common Injuries
All of these injuries (pericardial tamponade, myocardial contusion, and pulmonary contusion) are commonly associated with sternal fractures, as they can occur as a result of the same traumatic event that causes the sternal fracture 6, 2, 3.
Trauma-Related Complications
These injuries can have serious consequences, including cardiac arrest, respiratory failure, and even death if left untreated 2, 3, 4, 5.