Sternal trauma, is an uncommon occurrence, typically found in patients with blunt chest trauma or deceleration trauma (from motor vehicle accidents)¹. The incidence of sternal fracture is 3-6.8% of motor vehicle collisions¹.

Sternal fracture is typically diagnosed with sternal view plain film X-rays. Ultrasound is becoming increasingly used for patients with suspected sternal fracture but indeterminate plain films. The sensitivity is claimed to be 100%².

Isolated sternal fractures have a good prognosis, low mortality and are commonly treated on an outpatient basis^3,4. Concomitant injuries, however, can complicate the issue. These include:

1. Soft tissue injuries
   • pneumothoraces, hemothoraces, cardiac tamponade, myocardial, pulmonary contusions, abdominal and diaphragmatic injury
   • 6-12% of patients with sternal trauma will have an associated myocardial contusion⁴
2. Injuries to the chest wall
   • rib fractures, flail chest and sternoclavicular dislocation
3. Injuries to the spine, appendages and cranium

Complications from sternal injury include:

• Short term complications - musculoskeletal chest pain requiring analgesia to control. Poorly controlled chest pain can lead to impaired ventilation and pulmonary infection
• Long term complications - non-union, pseudoarthroses

Rare complications include osteomyelitis, sternal abscess formation and mediastinitis.

Management is typically conservative with sternal fractures. Certain sternal fractures do require operative management however. Displaced or unstable chest fractures (such as in this particular case) require operative fixation with sternal wires or osteosynthesis.

Case contributed by A/Prof. Pramit Phal.