Admission not needed for uncomplicated sternal fractures
Date First Published:
March 1, 2000
Last Updated:
April 5, 2013
Report by:
Andy Jones, Senior Registrar in Emergency Medicine (Manchester Royal Infirmary)
Search checked by:
Wendy Dollery, Manchester Royal Infirmary
Three-Part Question:
In [an adult with an isolated sternal fracture following a road traffic accident] is [routine admission] warranted to [detect possible cardiac events]
Clinical Scenario:
A 30 year old man presents having been involved in a front end collision while driving a car at 40mph. He is found to have sternal tenderness and an x-ray reveals a fracture. There are no other significant injuries.
Search Strategy:
Medline 1966 to 12/99 using the OVID interface.
Search Details:
[exp accidents traffic OR traffic ti.ab.sh] AND [exp sternum OR sternum ti.ab.sh] AND [exp fractures OR fractures.ti.ab.sh] LIMIT to human and English language
Outcome:
6 papers of which one was irelevant and 2 were of insufficient quality.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Sternal fractures: a retrospective analysis of 272 cases. Brookes JG, Dunn RJ, Rogers IR. 1993 Australia | 272 fractures over 6.5 years, 124 isolated fractures, 93% from RTA's | Retrospectice review | Accident details, fracture grade, cardiac sequalae | Isolated fracture minimal complications, arrythmias seen with age>65, IHD or digoxin | Possible missed fracrtures, retrospective design |
| Sternal fractures associated injuries and management. Hills MW, Delprado AM, Deane SA. 1993 Australia | 172 fractures over 6.5 years, 89% from RTA's | Prospective cohort study | Associated injuries | No clear association with intrathoracic injury. Slight increase in thoracic spine injury | Data collection uncertain, no uniform cardiac screen |
| Cardiac involvement in seatbelt - related and direct sternal trauma: a prospective study and management implications. Bu'Lock FA, Prothero A, Shaw C, Parry A, Dodds CA, Keenan J, Forfar JC. 1994 UK | 63 patients with central chest trauma, 45 seat belt related | Prospective cohort study | ECG findings and cardiac enzymes, echocardiography | None of these needed treatment and no adverse effects seen. ECG and enzymes correlated poorly with these findings. 25% of isolated seat belt injuries had pericardial effusion | Small numbers, not all had fractures |
Author Commentary:
Studies are not of the best quality. More rigorous prospective studies with larger numbers are required to make definite recommendations. Isolated sternal fractures caused by seat belts with no associated injuries and normal electrocardiography and chest radiology appear to be benign and can be discharged provided pain not severe. The situation with sternal fractures caused by other mechanisms is unclear.
Bottom Line:
Patients with isolated sternal fractures caused by seat belts who have a normal electrocardiography, chest radiography, and stable vital signs can be discharged.
References:
- Brookes JG, Dunn RJ, Rogers IR.. Sternal fractures: a retrospective analysis of 272 cases.
- Hills MW, Delprado AM, Deane SA.. Sternal fractures associated injuries and management.
- Bu'Lock FA, Prothero A, Shaw C, Parry A, Dodds CA, Keenan J, Forfar JC.. Cardiac involvement in seatbelt - related and direct sternal trauma: a prospective study and management implications.