Sternal fracture is a violation of the integrity of the sternum. It is accompanied by local swelling, bruising, intense pain, which increases with breathing. Displaced fragments of the sternum can damage the pleura and lungs, which leads to the development of pneumothorax and hemothorax. Diagnosis of sternal fractures is based on complaints, examination results and radiological data. Treatment consists in fixing the fracture site for a period of 14 days. In case of fractures of the sternum with displacement and multi-fragmented fractures, the fragments are repositioned and fixed with screws.
S22.2 Sternal fracture
Sternal fracture is rare, accounting for about 5% of the total number of closed traumatic chest lesions. It can be isolated or occur as part of combined chest injuries. In the latter case, it is associated with a fairly high mortality rate (from 25 to 45%) due to concomitant injuries of internal organs and severe respiratory disorders. For children’s patients, such fractures are uncharacteristic, since their chest is very elastic.
Sternal fracture causes
As a rule, chest injury with a sternum fracture occurs as a result of a traffic accident (when the chest hits the steering column), a strong direct blow to the chest or chest compression between deformed parts of the car and is combined with multiple rib fractures. Less often, the injury becomes a consequence of a sharp overextension with forced extension or extension of the body.
The sternum is a flat elongated bone located on the anterior surface of the chest. With its upper lateral sections, it connects to the collarbones. The cartilaginous parts of the ribs are attached to the sides of the sternum. The connection with the cartilages, which play the role of shock absorbers, provides sufficient mobility of the sternum, therefore, the application of significant traumatic force is required for the fracture to occur.
The most common localizations of fractures are the joint area of the body and the handle of the sternum, as well as the area of attachment of the fourth rib. When squeezed by a rolling wheel of a car or a moving press, Z-shaped fractures may develop in production. Damage may or may not be accompanied by displacement of fragments. In case of a fracture with displacement, the central part of the sternum is pressed inward.
Sternal fracture symptoms
The patient complains of pain at the site of injury. When breathing, the pain increases, so the patient tries to take shallow breaths. Edema and hemorrhages of varying severity are detected in the fracture area. Palpation is painful, sometimes during palpation it is possible to feel the fragments of the sternum. With the displacement of bone fragments, a visible deformation can be detected on the anterior surface of the chest. The entrapment of fragments of the sternum on inspiration is detected very rarely, usually with multi–fragmented fractures.
With a sternal fracture without displacement of the fragments, the pain may be relatively mild, especially if the injury is accompanied by multiple fractures of the ribs, which determine the main clinical symptoms. With isolated injuries of the sternum, the condition is more often satisfactory, there are no significant respiratory disorders. With a combined injury, the condition is often severe, shock is possible, pronounced respiratory disorders are detected.
With a sternal fracture with a large displacement of fragments, damage to the chest organs is possible. As a result of damage to the pleura and lungs, hemothorax (accumulation of blood) or pneumothorax (accumulation of air in the chest) may develop. A fairly common complication of such a fracture is a contusion of the heart. In the absence of urgent medical care, these complications pose a danger to the patient’s life.
The diagnosis of a sternum fracture is made by a traumatologist. Due to the insignificant prevalence of damage and non-intense pain in isolated fractures without displacement, sometimes there is a late request for medical help, errors in diagnosis. The survey plan includes the following activities:
- Survey. To increase the doctor’s alertness regarding a possible sternal fracture allows a carefully collected anamnesis with clarification of the characteristic mechanism of traumatic impact.
- External inspection. During an objective examination, attention is paid to the presence and location of bruises. Palpate the sternum to identify fragments and crepitation (bone crunch).
- Radiation techniques. Perform chest x-ray in direct and lateral projections. In most cases, the side shot is the most informative. In case of doubtful results of X-ray examination, CT is additionally prescribed.
With concomitant severe injuries of the chest, a consultation with a thoracic surgeon is indicated. With severe respiratory disorders, hemodynamic instability, signs of shock, an examination by a resuscitator is required.
Sternal fracture treatment
Treatment is carried out in the Department of Traumatology and Orthopedics. Local anesthesia of the fracture area is performed. All patients are prescribed painkillers. Immobilization is performed:
In case of a fracture without displacement of fragments, the damage site is fixed with a wide strip of adhesive plaster for a period of 2 weeks.
In case of a fracture with displacement, the fragments are repositioned. The patient is placed on a bed with a shield. A special roller is placed between the shoulder blades, thanks to which the patient’s body is in a state of overextension. The muscles pull the fragments of the sternum, and the displacement is gradually eliminated.
Physiotherapeutic methods of treatment include quartz, UHF, respiratory gymnastics to prevent congestion in the lungs.
Surgical treatment for fractures of the sternum is rarely required. In some cases (fractures with a large displacement of fragments and multi-fragmented injuries), open fixation of fragments is carried out. Osteosynthesis of the sternum is carried out using spokes, wire or special screws.
Prognosis and prevention
With isolated injuries, the prognosis is usually favorable. The sternal fracture completely fuses in about a month and a half. In case of combined injuries, multiple fractures and significant displacement of bone fragments, the outcome is determined by the severity of concomitant injuries to the chest organs. Prevention includes measures to prevent road and industrial injuries.
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