Excerpt from Fractures, Sternal

Synonyms, Key Words, and Related Terms: sternum fracture, sternum stress fractures, rib fractures, fracture of the sternum

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Background: 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.

Pathophysiology: Most sternal fractures are caused by blunt anterior chest trauma, although stress fractures have been noted in golfers, weight lifters, and other participants in noncontact sports. Insufficiency fractures can occur spontaneously in patients with osteoporosis or osteopenia (particularly in older persons), those on long-term steroid therapy, or those with severe thoracic kyphosis. Cardiopulmonary resuscitation commonly causes rib and sternal fractures, something that must be considered during the recovery process from the illness that lead to the cardiac arrest.

Frequency:

In the US: Motor vehicle collisions account for 60-90% of sternal fractures. Most of these patients used appropriate restraints. Those who were unrestrained generally sustained injury from ejection from the vehicle or impact with the steering wheel or dashboard. Direct impact sports, falls, vehicle-to-pedestrian accidents, and assaults account for most of the rest. Spontaneous fractures and stress fractures are rare.

Mortality/Morbidity: 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.

Race: No racial predilection is known.

Sex: Sternal fractures are slightly more common in females than in males, possibly because of shoulder restraint positioning; however, the difference is small.

Age: Sternal fractures are more common in patients older than 50 years, possibly because of a weaker or inelastic bony thorax. Because of the elasticity of their chest walls, children less commonly have sternal fractures; however, when present, the underlying injuries may be more severe.