Sternal fracture: Difference between revisions
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*Point tenderness over sternum | *Point tenderness over sternum | ||
*Ecchymosis, soft tissue swelling | *Ecchymosis, soft tissue swelling | ||
==Differential Diagnosis== | |||
{{Thoracic trauma DDX}} | |||
==Evaluation== | ==Evaluation== | ||
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==Management== | ==Management== | ||
*[[ECG]] | *[[ECG]] | ||
*Consider troponin | *Consider [[troponin]] | ||
**Surgeons tend to want | **Surgeons tend to want troponin | ||
**ED providers tend to defer | **ED providers tend to defer troponin if ECG normal | ||
==Disposition== | ==Disposition== | ||
Revision as of 18:49, 13 June 2020
Background
- Fracture is more likely in restrained passengers than unrestrained passengers
- Isolated sternal fracture is relatively benign
- Low mortality (<1%)
- Low intrathoracic morbidity
- May be associated with:
- Rib Fracture, Pulmonary Contusion
- Myocardial contusion (1.5%)
- No association between sternal fracture and aortic rupture
Clinical Features
- Anterior chest pain
- Point tenderness over sternum
- Ecchymosis, soft tissue swelling
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Evaluation
- Imaging
- Most are visible on lateral CXR or on ultrasound
Management
- ECG
- Consider troponin
- Surgeons tend to want troponin
- ED providers tend to defer troponin if ECG normal
Disposition
- Isolated, non-displaced fracture:
- If pain control achieved and ECG normal ok to discharge home
- Displaced fracture or concern for severe pain or respiratory compromise:
- Refer for operative fixation