From the Guidelines
Treatment for a xiphoid process fracture typically involves conservative management, with surgery being considered only when fracture fragments are large, articular, or significantly displaced. The diagnosis of a xiphoid process fracture is based on a history of trauma and focal pain on palpation, and is confirmed with radiographic studies 1. When fracture fragments are small, nonarticular, or minimally displaced, simple immobilization is often appropriate.
Key Considerations
- A xiphoid process fracture is a break in the small, cartilaginous extension at the bottom of the sternum.
- Conservative management includes rest, ice application, and pain control with medications such as acetaminophen or NSAIDs like ibuprofen for 1-2 weeks as needed.
- Activities that aggravate pain should be avoided, and a supportive pillow can be used when coughing to reduce discomfort.
- Most fractures heal within 4-6 weeks without intervention, but medical attention is warranted for severe pain, breathing difficulties, or signs of internal injury.
Management Approach
- The xiphoid process is vulnerable during CPR or trauma, and fractures occur because this structure is less protected than the rest of the sternum.
- Proper pain management and activity modification are crucial for comfort during the healing process, as indicated by the american college of foot and ankle surgeons: diagnosis and treatment of heel pain study 1.
- While usually not serious, a xiphoid process fracture requires careful management to ensure proper healing and prevent complications.
From the Research
Xiphoid Process Fracture
- A xiphoid process fracture can be a rare but debilitating condition, often misdiagnosed as cardiac disease due to its location in the anterior chest 2.
- The xiphoid process can become elongated and reconnected with the sternum after a fracture, leading to neogenesis and potentially causing pain and discomfort 3.
- Xiphodynia, or pain radiating from the xiphoid process, can be caused by a variety of factors, including GERD, gall-bladder disease, angina pectoris, and coronary-artery disease 2.
Treatment Options
- Treatment for xiphodynia can range from conservative management to injections or xiphoidectomy, depending on the patient's individual case and degree of severity 2, 4, 5.
- Xiphoidectomy, or surgical resection of the xiphoid process, has been shown to be a safe and effective treatment option for intractable xiphodynia, with significant pain relief achieved in the majority of patients 4, 5.
- However, patients who have undergone previous surgery affecting the xiphoid process may be less likely to benefit from xiphoidectomy 4.
Anatomic Evaluation
- The xiphoid process can exhibit significant interindividual variations, including differences in shape, size, and orientation 6.
- Multidetector computed tomography (MDCT) can be used to evaluate the anatomic features of the xiphoid process and detect variations 6.
- Understanding the anatomy of the xiphoid process is important for diagnosing and treating conditions such as xiphodynia and xiphoid process fractures 6.