The Association between Blunt Cardiac Injury and Isolated Sternal Fracture

Area of Science:

• Trauma Surgery
• Cardiology
• Emergency Medicine

Background:

• Isolated sternal fractures (ISF) have heterogeneous global treatment protocols.
• There is a need to understand the incidence, morbidity, and mortality of ISF.
• Current diagnostic and management practices for ISF and associated cardiac injury require evaluation.

Purpose of the Study:

• To determine the incidence, morbidity, and mortality of isolated sternal fractures.
• To describe the diagnostic and management strategies for ISF and cardiac injury.
• To assess the necessity of hospital admission for ISF patients.

Main Methods:

• Retrospective cohort study of adult patients (>16 years) with ISF.
• Data collected from 2006 to 2010 at a UK Level I trauma center.
• Analysis included patient demographics, hospital admission, EKG, serum cardiac markers (troponin), and echocardiograms.

Main Results:

• Eighty-eight patients with ISF were identified.
• No clinically significant cardiac injury was found in any patient.
• Only 2% of patients had transiently elevated troponin levels; 2% had abnormal EKGs that resolved.

Conclusions:

• Patients with isolated sternal fractures and normal EKG/chest X-ray show no significant cardiac injury.
• Hospital admission is not warranted for ISF patients presenting with normal EKG and chest X-ray.
• Early ER discharge is a safe management strategy for select ISF patients.