Fracture of the sternum in children
L P Ferguson1, A G Wilkinson, T F Beattie
1Department of Accident and Emergency Medicine, Royal Hospital for Sick Children, Edinburgh, Scotland.
Insights
Pediatric sternal fractures are uncommon and often result from minor blunt trauma, unlike adult injuries. Most fractures involve the anterior cortex, and isolated injuries can be safely managed.
Area of Science:
- Pediatric Traumatology
- Pediatric Radiology
- Orthopedic Surgery
Background:
- Sternal fractures are not well-documented in pediatric populations.
- Understanding injury mechanisms and associated injuries is crucial for appropriate management.
Purpose of the Study:
- To investigate the mechanisms of injury for pediatric sternal fractures.
- To describe the radiological features of these fractures.
- To identify associated injuries in children with sternal fractures.
Main Methods:
- Retrospective review of pediatric patients with sternal fractures.
- Analysis of plain radiography and computed tomography scans of the sternum and thorax.
- Data collected over a 40-month period at a dedicated children's hospital.
Main Results:
- 12 out of 33 identified children had radiological evidence of sternal fracture (age range 5-12 years).
- Most fractures involved the anterior cortex of the first or second sternebra; one involved the manubriosternal joint.
- Fractures resulted from direct blows (7) or hyperflexion injuries (5), not motor vehicle crashes; all were isolated injuries.
Conclusions:
- Pediatric sternal fractures are rare and can occur from less severe blunt trauma than previously thought.
- Indirect violence causing sternal fracture necessitates thorough spinal examination.
- Undisplaced anterior cortical fractures without other injuries may allow for emergency department discharge.
Objective:
Sternal fracture is poorly characterised in children. The purpose of this study was to gain insight into the mechanism, radiological characteristics, and accompanying injuries of sternal fracture in children.
Methods:
The study was retrospective. The records of all children who underwent plain radiography of the sternum, or computed tomography of the thorax after trauma, over a 40 month period in our paediatric hospital were reviewed for evidence of sternal fracture.
Results:
12 of 33 children identified had radiological evidence of sternal fracture. The age range of children with fractures was 5 to 12 years. Eleven children had fracture of the anterior cortex of the first or second sternebra of the body of the sternum. One child had fracture through the manubriosternal joint with posterior displacement of the body. Seven fractures resulted from direct blows to the anterior chest, five fractures resulted from hyperflexion injury of the thoracic spine. None were the result of motor vehicle crash. All fractures were isolated injuries.
Conclusions:
Sternal fracture is uncommon in children. Injury may result from direct or indirect violence. The child's sternum is commonly fractured by more minor blunt trauma than generally recognised in the literature. All patients with sternal fracture after indirect violence should have careful examination of the spine. Patients with undisplaced anterior cortical fracture without other injury may be safely discharged from the emergency department.
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