Sternal fracture
From Wikipedia, the free encyclopedia
| Sternal fracture Classification and external resources |
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| ICD-10 | S22.2 |
|---|---|
| ICD-9 | 807.2, 807.3 |
| eMedicine | emerg/206 radio/654 |
A sternal fracture is a fracture of the sternum (the breastbone), which is located in the center of the chest. The injury, which occurs in 5–8% of people who experience significant blunt chest trauma, may occur in vehicle accidents, when the still-moving chest strikes a steering wheel or dashboard[1] or is injured by a seatbelt.[2] Sternal fracture can interfere with breathing by making it more painful; however the main reason it is significant is that that it indicates that there may be serious associated injuries, e.g. to the heart and lungs.[3]
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[edit] Causes
The usual cause of sternal fracture is a vehicle collision.[3] The chest of a driver who is not wearing a seat belt may strike the steering wheel, and the shoulder component of a seatbelt may injure the chest if it is worn without the lap component.[3]
The injury can also occur when the chest suddenly flexes, in the absence of an impact.[2] Most sternal fractures occur below the sternal angle.[1]
[edit] Associated injuries
Because of the high frequency of associated injuries, clinicians are taught to suspect that a patient has multiple severe injuries if a sternal fracture is present.[4] Sternal fracture is commonly associated with injuries to the heart and lungs; if a person is injured with enough force to fracture the sternum injuries such as myocardial and pulmonary contusions are likely.[1] Other associated injuries that may occur include damage to blood vessels in the chest, myocardial rupture, head and abdominal injuries, flail chest,[1] and vertebral fracture.[2] Sternal fractures may also accompany rib fractures and are high-energy enough injuries to cause bronchial tears (ruptures of the bronchioles).[5] They may hinder breathing.[5] Due to the associated injuries, the mortality rate for people with sternal fracture is high, at an estimated 25–45%.[1]
[edit] Signs and symptoms
Signs and symptoms include crepitus (a crunching sound made when broken bone ends rub together),[1] pain, tenderness, bruising, and swelling over the fracture site.[4] The fracture may visibly move when the person breathes, and it may be bent or deformed,[4] potentially forming a "step" at the junction of the broken bone ends that is detectable by palpation.[3] Associated injuries such as those to the heart may cause symptoms such as abnormalities seen on electrocardiograms.[1]
[edit] Treatment
Treatment involves treating associated injuries; people with sternal fractures but no other injuries do not need to be hospitalized.[4] Analgesics can be given to reduce pain, and patients are instructed to avoid moving.[4] Fractures that are very painful or extremely out of place can be operated on to fix the bone fragments into place.[4]
[edit] References
- ^ a b c d e f g Beck RJ, Pollak AN, Rahm SJ (2005). "Thoracic trauma", Intermediate Emergency Care and Transportation of the Sick and Injured. Boston: Jones and Bartlett. ISBN 0-7637-2244-8. Retrieved on 2008-06-11.
- ^ a b c Smith M, Ball V (1998). Cardiovascular/respiratory physiotherapy. St. Louis: Mosby, 217. ISBN 0-7234-2595-7. Retrieved on 2008-06-12.
- ^ a b c d Marini JJ, Wheeler AP (2006). Critical Care Medicine: The Essentials. Hagerstwon, MD: Lippincott Williams & Wilkins, 580. ISBN 0-7817-3916-0. Retrieved on 2008-06-12.
- ^ a b c d e f Livingston DH, Hauser CJ (2004). "Trauma to the chest wall and lung", in Moore EJ, Feliciano DV, Mattox KL: Trauma. New York: McGraw-Hill, Medical Pub. Division, 517. ISBN 0-07-137069-2. Retrieved on 2008-06-11.
- ^ a b Hwang JCF, Hanowell LH, Grande CM (1996). "Peri-operative concerns in thoracic trauma". Baillière's Clinical Anaesthesiology 10 (1). doi:.
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