Clinical significance of isolated sternal fracture

Isolated sternal fractures (ISF) are uncommon injuries and after exclusion of other concomitant injuries, ISF can be classified as harmless injuries, and can be treated on outpatient basis.

Based on literature and own experience to make a simple algorithm in the diagnosis and treatment of ISF.

Retrospective analysis of medical records of patients who were admitted with ISF to the Clinic for Thoracic Surgery of UCC Sarajevo between January 2000 and January 2010.

A review included 49 patients with ISF. The average age was 52.67 +/- 12.42 (range 21 to 81) years. Age group between 41 and 61 years was significantly more prone to ISF. Male/female ratio was 2.2:1 (34/15). The major cause of the injury, seen in 77.6% (38/49) cases, was an involvement in road traffic accidents (RTAs). Statistically, there is a significant difference (chi2 = 6.74; p = 0.009) in the frequency of occurrence ISF between drivers [55.1% (27/38)] and passengers [22.4% (11/39)]. Of the remaining eleven patients, four ISF were caused by falls at home, and seven by direct violence to the chest either in sport or in a fight. The sternal view radiography was diagnostic in all patients In most patients [83.7% (41/49)] the enzymatic values were elevated. ECGs were recorded in all cases, of which only 12.2% (6/49) had an abnormality. The average duration of hospitalization was 3.57 +/- 2.01 (range 1 to 7) days. It should be noted that 34.7% of patients were discharged in less than 24h and 73.5% were discharged in under 48h. Commonly used analgesic, metamizol, was applied in 98.0% (48/49) of cases. The combination of tramadol and metamizol was given in 63.3% (32/49) of patients.

Established results support the view that patients with ISF and no abnormality in ECG and cardiac enzymes during the early hours after injury are expected to have a benign course and can be discharged home within the first 24 to 48 hours. Proposed algorithm can be of assistance In making such decisions.