Sternal fractures: Associated injuries and management

Prospective data from blunt trauma victims admitted to one hospital were analyzed to determine the significance of sternal fractures and possible associated injuries. A total of 12,618 patients were admitted over a 6 1/2 year period, of whom 2226 (17.6%) were injured while in a motor vehicle. One hundred seventy-two sternal fractures were recorded with 152 (89%) occurring in motor vehicle occupants. Vehicle occupants with sternal fractures included a greater proportion of patients over 50 years (56% vs. 11%), more females (55% vs. 34%) and more seat belt wearers (70% vs. 40%). There was no association with serious visceral chest injury (including cardiac contusion). There was an association with thoracic spine fractures (Chi-squared 5.871, df=1, p< 0.05). Sternal fractures in motor vehicle occupants were associated with less injury overall (median ISS = 5.5) compared with those without sternal fractures (median ISS = 13). Assessment of such patients should include age and injury mechanism to reduce the rate of admission and investigation of patients whose sole injury is a sternal fracture without significant pain.