Sternal fractures are predominantly associated with deceleration injuries and blunt anterior chest trauma (incidence of 3-6.8% in motor vehicle collisions). Consider the diagnosis on the basis of the mechanism of injury. Direct trauma is the most common cause of injury (eg, motor vehicle accidents, sports, and falls).
Fractures usually occur at the body or the manubrium. Lateral chest radiograph is considered the gold standard for making the diagnosis, because fracture and displacement or dislocation occurs in the sagittal plane. An anteroposterior chest radiograph can be helpful in detecting other injuries, such as rib fracture, pulmonary contusion, hemothorax, and pneumothorax. Ultrasonography demonstrates sternal fractures with as much sensitivity as plain radiography and can accurately identify related hematomas and pleural effusions, but it is ltrasound is not accurate in identifying the degree of displacement of sternal fractures.
Lateral radiograph shows a complete displaced fracture of the sternum (arrow).
Most sternal fractures are caused by blunt anterior chest trauma. Insufficiency fractures caused by abnormally decreased bone density or weakened bone can occur spontaneously in patients with osteoporosis or osteopenia (particularly in older persons, especially women), those on long-term steroid therapy, or those with severe thoracic kyphosis. Cardiopulmonary resuscitation commonly causes rib and sternal fractures.
Almost all patients complain of localized sternal pain. Pain may be more diffuse in patients with insufficiency fractures and may lead to a more extensive differential diagnosis for chest pain in an older population.
Consider at least an observation admission for elderly persons with chest wall fractures because these patients are at increased risk for respiratory compromise and atelectasis.