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What is the diagnosis?

The patient is diagnosed with a sternal fracture. These fractures are associated with deceleration injuries and trauma to the anterior chest [1]. Patients present with chest pain that worsens with respirations and shortness of breath [2].

• Pearl: An AP and lateral chest x-ray is the initial imaging modality of choice. However, a CT scan can be performed to better characterize the fracture and its sequelae [2].

Image 2: Case courtesy of Dr Jayanth Keshavamurthy, Radiopaedia.org, rID: 38447

What is the management in the ED?

Management in the ED follows ATLS guidelines and resuscitation. These injuries are frequently associated with other injuries, such as hemothorax, pneumothorax, and flail chest. The mainstay of treatment in isolated, nondisplaced fractures is analgesia. Displaced fractures may require operative management by the trauma team. Similar to management of rib fractures, deep breathing and incentive spirometry is recommended to avoid pulmonary complications [1,2].

• Pearl: Look for blunt cardiac injury in these patients. Cardiac biomarkers, an ECG, and telemonitoring should be performed in patients presenting with this injury [1].

What is the disposition?

Isolated, nondisplaced sternal fractures in patients without evidence of cardiac injury can be safely discharged with close follow-up. If pain control is an issue or there are additional underlying injuries, admission is likely warranted. 

Who do you consult?

Consultation will depend on institutional protocols, but would likely involve either trauma surgery or cardiothoracic surgery. Those with signs of blunt cardiac injury should be admitted for further monitoring [1].