Sternal fractures are relatively common and range from simple unicortical cracks to displaced fractures associated with life threatening injuries. This paper describes the relevant anatomy, biomechanics, mechanism of injury, clinical presentation, investigation, treatment and complications and also includes associated and concomitant injuries. A management flow chart including criteria for discharge from the emergency department is presented.
Appelboam A., McLauchlan CA, Murdoch J., MacIntyre PA2006. Delivery of local anaesthetic via a sternal catheter to reduce the pain caused by sternal fractures: first case series using the new technique. Emerg Med J23: 791-3.
2.
Athanassiadi K., Gerazounis M., Moustardas M., Metaxas E.2002. Sternal fractures: retrospective analysis of 100 cases . World J Surg26: 1243-6.
3.
Ayrik C., Cakmakci H., Yanturali S., Ozsarac M., Ozucelik DN2005. A case report of an unusual sternal fracture. Emerg Med J22: 591-3.
4.
Barbaix EJ1996. Stress fracture of the sternum in a golf player . Int J Sports Med17: 303-4.
5.
Berg EE1993. The sternal-rib complex. A possible fourth column in thoracic spine fractures. Spine 1;18: 1916-9.
6.
Bertin KC, Rice RS, Doty DB, Jones KW2002. Repair of transverse sternal nonunions using metal plates and autogenous bone graft. Ann Thorac Surg73: 1661-2.
7.
Bitschnau R., Gehmacher O., Kopf A., Scheier M., Mathis G.1997. Ultrasound diagnosis of rib and sternum fractures . Ultraschall Med18: 158-61 (German).
8.
Blacksin MF1993. Patterns of fracture after air bag deployment. J Trauma35: 840-3.
9.
Bowen AP1999. Projectile lawn mower injuries in children: two case reports . J Emerg Nurs25: 168-70.
10.
Brookes JG, Dunn RJ, Rogers IR1993. Sternal fractures: a retrospective analysis of 272 cases . J Trauma35: 46-54.
11.
Carey S., Pezzella AT, Gilliam H.1988. Traumatic sternal fractures: current concepts in diagnosis and management. Mil Med153: 451-3.
12.
Chiu WC, D'Amelio LF, Hammond JS1997. Sternal fractures in blunt chest trauma: a practical algorithm for management. Am J Emerg Med15: 252-5.
13.
Chi YL1979. Fracture of sternum in children: report of 3 cases (author's transl). Zhonghua Wai Ke Za Zhi17: 495 (Chinese).
14.
Chen C., Chandnani V., Kang HS, Schils JP, Resnick D., Bjorkengren AG, Kaplan P.1990. Insufficiency fracture of the sternum caused by osteopenia: plain film findings in seven patients. AJR Am J Roentgenol154: 1025-7.
15.
Cooper KL1988. Insufficiency fractures of the sternum: a consequence of thoracic kyphosis? Radiology167: 471-2.
Dastgeer GM, Mikolich DJ1987. Fracture-dislocation of manubriosternal joint: an unusual complication of seizures. J Trauma. 27: 91-3. Erratum in: J Trauma.27: 329.
18.
DeFriend DE, Franklin K.2001. Isolated sternal fracture-a swing-related injury in two children. Pediatr Radiol31: 200-2.
19.
De Oliveira M., Hassan TB, Sebewufu R., Finlay D., Quinton DN1998. Long-term morbidity in patients suffering a sternal fracture following discharge from the A and E department. Injury29: 609-12.
20.
De Tarnowsky G. VII.1905. Contrecoup fracture of the sternum . Ann Surg41: 252-64.
21.
Duncan MA, McNicholas W., O'Keeffe D., O'Reilly M.2002. Periosteal infusion of bupivacaine/morphine post sternal fracture: a new analgesic technique. Reg Anesth Pain Med27: 316-8.
22.
Enat R., Pollack S., Wiener M., Barzilai D.1979. Osteomyelitis in fractured sternum after cardiopulmonary resuscitation. N Engl J Med12; 301: 108-9.
23.
Engin G., Yekeler E., Güloğlu R., Acunaş B., Acunaş G.2000. US versus conventional radiography in the diagnosis of sternal fractures. Acta Radiol41: 296-9.
24.
Erhan Y., Solak I., Kocabas S., Sözbilen M., Kumanlioğlu K., Moral AR2001. The evaluation of diagnostic accordance between plain radiography and bone scintigraphy for the assessment of sternum and rib fractures in the early period of blunt trauma. Ulus Travma Derg7: 242-5.
25.
Ferguson LP, Wilkinson AG, Beattie TF2003. Fracture of the sternum in children. Emerg Med J20: 518-20.
26.
Fowler AW1957. Flexion-compression injury of the sternum. J Bone Joint Surg Br39-B: 487-97.
27.
Gallo DR, Lett ED, Conner WC2006. Surgical repair of a chronic traumatic sternal fracture . Ann Thorac Surg81: 726-8.
28.
Geusens E., Pans S., Prinsloo J., Fourneau I.2005. The widened mediastinum in trauma patients. Eur J Emerg Med12: 179-84.
29.
Gregory PL, Biswas AC, Batt ME2002. Musculoskeletal problems of the chest wall in athletes . Sports Med32: 235-50 (Review).
30.
Gibson LD, Carter R., Hinshaw DB1962. Surgical significance of sternal fracture. Surg Gynecol Obstet114: 443-8.
31.
Gopalakrishnan KC, el Masri WS1986. Fractures of the sternum associated with spinal injury . J Bone Joint Surg Br68: 178-81.
32.
Gouldman JW, Miller RS1997. Sternal fracture: a benign entity? Am Surg63: 17-9.
33.
Grosse A., Grosse C., Steinbach L., Anderson S.2007. MRI findings of prolonged post-traumatic sternal pain . Skeletal Radiol36: 423-9.
34.
Hechter S., Huyer D., Manson D.2002. Sternal fractures as a manifestation of abusive injury in children. Pediatr Radiol32: 902-6.
35.
Hendrickson SC, Koger KE, Morea CJ, Aponte RL, Smith PK, Levin LS1996. Sternal plating for the treatment of sternal nonunion . Ann Thorac Surg62: 512-8.
36.
Hendrich C., Finkewitz U., Berner W.1995. Diagnostic value of ultrasonography and conventional radiography for the assessment of sternal fractures. Injury26: 601-4.
37.
Heyes FL, Vincent R.1993. Sternal fracture: what investigations are indicated ? Injury24: 113-5.
38.
Hill PF, Chatterji S., DeMello WF, Gibbons JR1997. Stress fracture of the sternum: an unusual injury ? Injury28: 359-61.
Höcker K., Renner J.1994. Sternum fracture-description of this injury based on 100 patient follow-up studies and review of the literature. Unfallchirurg97: 256-62 (German).
41.
Holderman HH1928. Fracture and dislocation of the sternum: Report of three cases. nn Surg.88: 252-9.
42.
Horikawa A., Miyakoshi N., Kodama H., Shimada Y.2007. Insufficiency fracture of the sternum simulating myocardial infarction: case report and review of the literature.Tohoku. J Exp Med211: 89-93.
Illig KA, Swierzewski MJ, Feliciano DV, Morton JH1991. A rational screening and treatment strategy based on the electrocardiogram alone for suspected cardiac contusion. Am J Surg162: 537-43 (discussion 544).
45.
Inweregbu K., Blackburn A.2000. Management of sternal fracture pain using bupivacaine via a subcutaneous cannula. Acute Pain3: 44-5.
46.
Jackson M., Walker WS1992. Isolated sternal fracture: a benign injury? Injury23: 535-6.
47.
Jaschke W.1981. Sternum fracture in a 12-year-old boy. Chirurg52: 51-2 Review (German).
48.
Jin W., Yang DM, Kim HC, Ryu KN2006. Diagnostic values of sonography for assessment of sternal fractures compared with conventional radiography and bone scans . J Ultrasound Med25: 1263-8.
49.
Johnson I., Branfoot T.1993. Sternal fracture-a modern review. Arch Emerg Med10: 24-8 (Review).
50.
Jones A.1998. Towards evidence based emergency medicine: best BETS from the Manchester Royal Infirmary. Admission of isolated sternal fracture for observation. J Accid Emerg Med15: 227-8.
51.
Jones HK, McBride GG, Mumby RC1989. Sternal fractures associated with spinal injury . J Trauma29: 360-4.
52.
Jones A.1998. Towards evidence based emergency medicine: best BETS from the Manchester Royal Infirmary. Admission of isolated sternal fracture for observation. J Accid Emerg Med15: 227-8.
53.
Juan CW, Wu FF, Lee TC, Chen FC, Hu YR, Yu YT2002. Traumatic cardiac injury following sternal fracture: a case report and literature review. Kaohsiung J Med Sci18: 363-7.
54.
Karev DV1997. Operative management of the flail chest. Wiad Lek50: 205-8.
55.
Kinsella TJ, White SM, Koucky RW1947. Two unusual tumors of the sternum. J Thorac Surg16: 640.
56.
Kitchens J., Richardson JD1993. Open fixation of sternal fracture. Surg Gynecol Obstet177: 423-4.
57.
Kläber V.1979. Sternal fracture in a 12-year-old. Zentralbl Chir104: 244-5.
58.
Knobloch K., Wagner S., Haasper C., Probst C., Krettek C., Otte D., Richter M.2006. Sternal fractures occur most often in old cars to seat-belted drivers without any airbag often with concomitant spinal injuries: clinical findings and technical collision variables among 42,055 crash victims . Ann Thorac Surg82: 444-50.
59.
Kusaba A., Saito S.2003. Apophyseal dislocation of the body of the sternum in a child: a case report. J Orthop Trauma17: 126-8.
60.
Larson CM, Fischer DA2003. Injury to the developing sternum in an adolescent football player: a case report and literature review. Am J Orthop32: 559-61 (Review).
61.
Latzin P., Griese M., Hermanns V., Kammer B.2005. Sternal fracture with fatal outcome in cystic fibrosis . Thorax60: 616.
62.
Mahlfeld A., Franke J., Mahlfeld K.2001. Jan; Ultrasound diagnosis of sternum fractures . Zentralbl Chir126: 62-4 (German).
63.
Mallinson RH, Tremlett CH, Payne BV, Richards JE1999. Sternal osteomyelitis after cardiopulmonary resuscitation . J R Soc Med92: 87.
Mensah GA, Gold JP, Schreiber T., Isom OW1988. Acute purulent mediastinitis and sternal osteomyelitis after closed chest cardiopulmonary resuscitation: a case report and review of the literature. Ann Thorac Surg46: 353-5 (Review).
66.
Metaxas EK, Condilis N., Tzatzadakis N., Dervisoglou A., Gerazounis MI, Athanasas G.2006. Sternal fracture with or without associated injuries. Assessment of the difference in the diagnosis, management and complications . Eighteen years of experience. Ann Ital Chir77: 379-83.
67.
Miyoshi H., Otsuka N., Sone T., Nagai K., Tamada T., Mimura H., Yanagimoto S., Tomomitsu T., Fukunaga M.1999. Chronological study for solitary bone metastasis in the sternum from breast cancer with bone scintigraphy. Kaku Igaku36: 419-24 (Japanese).
68.
Newman RJ, Jones IS1984. A prospective study of 413 consecutive car occupants with chest injuries. J Trauma24: 129-35.
69.
Otremski I., Wilde BR, Marsh JL, McLardy Smith PD, Newman RJ1990. Fracture of the sternum in motor vehicle accidents and its association with mediastinal injury. Injury21: 81-3.
70.
Park WM, McCall IW, McSweeney T., Jones BF1980. Cervicodorsal injury presenting as sternal fracture . Clin Radiol31: 49-53.
71.
Peek GJ, Firmin RK1995. Isolated sternal fracture: an audit of 10 years' experience . Injury26: 385-8.
72.
Pérez-Martínez A., Marco-Macián A., GonzálvezPiñera J., Agustí-Buztke B., Solera Santos G., GoñiOrayen C., Moya-Marchante M.1996. Cortical fracture of the sternum in a child: an infrequent case. Cir Pediatr9: 130-1 (Spanish).
73.
Perez FL Jr, Coddington RC1983. A fracture of the sternum in a child. J Pediatr Orthop3: 513-5.
74.
Popovici B., Goia A.2007. Diagnostic, therapeutic and prognostic significance of sternal fractures. Pneumologia56: 190-3 (Romanian).
75.
Potaris K., Gakidis J., Mihos P., Voutsinas V., Deligeorgis A., Petsinis V.2002. Management of sternal fractures: 239 cases. Asian Cardiovasc Thorac Ann10: 145-9.
76.
Graham TR1993. Sternal fractures. Br J Hosp Med50: 107-12 (Review).
77.
Rajić S., Rakić D., Zivković S., Milojković M.1970. A case of sternal fracture in a child. Srp Arh Celok Lek98: 119-24 (Serbian).
78.
Randell PA, Somers L.2006. Case of the month: ``bugs are eating my soul''-sternal abscess, osteomyelitis, and mediastinitis complicating a closed sternal fracture . Emerg Med J23: 736-7.
Roy-Shapira A., Levi I., Khoda J.1994. Sternal fractures: a red flag or a red herring? . J Trauma37: 59-61.
86.
Saab M., Kurdy NM, Birkinshaw R.1997. Widening of the mediastinum following a sternal fracture . Int J Clin Pract51: 256-7.
87.
Sarquis G., Vélez SE, Suizer A., Reche F.2003. Diagnostic and therapeutic options for traumatic sternal fractures. Rev Fac Cien Med Univ Nac Cordoba60: 13-8 (Spanish).
88.
Schapira D., Nachtigal A., Scharf Y.1995. Spontaneous fracture of the sternum simulating myocardial infarction. Clin Rheumatol14: 478-80.
89.
Scher AT1983. Associated sternal and spinal fractures. Case reports . S Afr Med J64: 98-100.
90.
Sommer C.2005. Fixation of transverse fractures of the sternum and sacrum with the locking compression plate system: two case reports. J Orthop Trauma19: 487-90.
91.
Sturm JT, Luxenberg MG, Moudry BM, Perry Jr JF1989. Does sternal fracture increase the risk for aortic rupture? . Ann Thorac Surg48: 697-8.
Velissaris T., Pontefract D., Ohri S.2002. A giant sternal abscess following traumatic sternal fracture . Eur J Cardiothorac Surg22: 439.
94.
Vioreanu MH, Quinlan JF, Robertson I., O'Byrne JM2005. Vertebral fractures and concomitant fractures of the sternum . Int Orthop29: 339-42.
95.
Vodicka J., Spidlen V., Safránek J., Simánek V., Altmann P.2007. Severe injury to the chest wall-experience with surgical therapy. Zentralbl Chir132: 542-6 (German).
96.
von Garrel T., Ince A., Junge A., Schnabel M., Bahrs C.2004. The sternal fracture: radiographic analysis of 200 fractures with special reference to concomitant injuries. J Trauma57: 837-44.
97.
Watkins R., Watkins R., Williams L., Ahlbrand S., Garcia R., Karamanian A., Sharp L., Vo C., Hedman T.2005. Stability provided by the sternum and rib cage in the thoracic spine. Spine30: 1283-6.
98.
Wedde TB, Quinlan JF, Khan A., Khan HJ, Cunningham FO, McGrath JP2007. Fractures of the sternum: the influence of non-invasive cardiac monitoring on management. Arch Orthop Trauma Surg127: 121-3.
99.
Wiener Y., Achildiev B., Karni T., Halevi A.2001. Echocardiogram in sternal fracture. Am J Emerg Med19: 403-5.
100.
Wright SW1993. Myth of the dangerous sternal fracture. Ann Emerg Med22: 1589-92.
101.
Wu LC, Renucci JD, Song DH2005. Sternal nonunion: a review of current treatments and a new method of rigid fixation. Ann Plast Surg54: 55-8 (Review).
102.
Wu LC, Renucci J., Song DH2004. Rigid-plate fixation for the treatment of sternal nonunion . J Thorac Cardiovasc Surg128: 623-4.
