A 43-year-old man presented with chest pain after a motor vehicle collision where he was thrown into the steering wheel. He was found to have a sternal contusion and tenderness over the sternum. Radiographs showed a complete sternal dislocation. The document recommends an initial workup to screen for other injuries, CT of the chest, pain management, and ECG monitoring given the potential for associated injuries from blunt chest trauma. While sternal fractures were once thought to have high morbidity, recent evidence shows lower risks if no other injuries are present.

2.  43 YOM with a pmhx notable for
hypertension presents following
a motor vehicle collision. He was
the unrestrained driver of a
vehicle traveling approx. 35mph
on a local street – he explains
that he was distracted and
collided with the rear end of a car
stopped at an intersection and
was thrown into the steering
wheel of his car. He denies LOC;
he is complaining of mid chest
pain worse with deep inspiration;
he denies dyspnea. He feels
otherwise well denying other
pain or associated injury. He is
awake/alert, conversational in
NAD.
 T 98.7 P 95 BP 164/90 O2 98%
 Gen: WDWN
 CV: RRR, no m/r/g, cr<3 sec
globally. Pulses 2/4 in 4
extremities.
 Pulm: Lungs CTA bilat, BBSE,
pt shows obvious contusion
overlying the sternum; he is
tender to palpation over the
associated soft tissue. There is
no other injury appreciable –
he has good rise and fall of his
chest with insp./exp.
 Abd: no signs of trauma,
soft/nt/nd.

4. Lateral radiograph
demonstrates complete
dislocation at the sternal
angle
Upright frontal radiograph shows
mild widening of the superior
mediastinum after blunt trauma to
the chest

5.  Oxygen
 IV Fluids
 Diagnostics
 Initial work-up should include complete screening for associated traumatic
injuries included but not limited to cardiac tamponade, flail chest, cardiac
contusion pulmonary contusion, thoracic spine injury, etc.
 CT Chest is typically indicated to evaluate for mediastinal injuries
 Medical management
 ER medical management of an isolated sternal fracture in a stable patient is
similar to that for uncomplicated rib fracture including adequate pain
management and incentive spirometry.
 In the setting of isolated sternal fracture it is recommended an ecg be
obtained initially and again at 6 hours prior to discharge.

6.  Outcome
 Sternal fractures were once thought to be high-morbidity injuries,
with a mortality rate of 25-45% from associated injuries. Recent
literature reveals that the morbidity rate may be lower, yet caution is
warranted when evaluating and treating patients with this injury
 The mortality rate from isolated sternal fracture is extremely low.
Death and morbidity are related almost entirely to associated
injuries such as aortic disruption, cardiac contusion, and pulmonary
contusion, or unrelated injuries to the abdomen or head sustained
in the accident.
 Mechanism
 Most sternal fractures are caused by blunt anterior chest truama.
 Motor vehicle collisions account for 60-90% of sternal fractures
.