Pediatric sternal fractures: A single center retrospective review
Alexander V Chalphin1, David P Mooney1
1Department of Surgery, Boston Children's Hospital and Harvard Medical School Boston, MA.
Insights
Pediatric sternal fractures are typically isolated injuries with low morbidity. Stable children with isolated sternal fractures can be managed without hospital admission, avoiding unnecessary investigations for intrathoracic injuries.
Area of Science:
- Pediatric Traumatology
- Orthopedic Surgery
- Emergency Medicine
Background:
- Sternal fractures in children are uncommon injuries.
- Understanding their diagnosis, management, and outcomes is crucial for appropriate patient care.
Purpose of the Study:
- To investigate the diagnosis, management, and outcomes of pediatric sternal fractures.
- To evaluate the necessity of aggressive workup for associated injuries.
Main Methods:
- Retrospective review of a trauma registry and hospital data warehouse.
- Inclusion of radiologically confirmed sternal fractures in patients under 21 years old.
- Extraction of demographics, injury mechanisms, diagnostic methods, associated injuries, and outcomes.
Main Results:
- 65 pediatric sternal fractures identified; 71% male, median age 11 years.
- Most fractures were isolated (77%) with no reported cardiac or aortic injuries or deaths.
- Chest X-ray was the primary diagnostic tool (63%); 45% of ED presentations were admitted, with 39% having isolated fractures.
Conclusions:
- Pediatric sternal fractures are predominantly isolated injuries with low associated morbidity.
- Isolated sternal fractures in stable children do not warrant aggressive intrathoracic injury workup.
- Outpatient follow-up is a safe management strategy for stable pediatric sternal fractures.
Purpose:
We sought to investigate the diagnosis, management, and outcomes of pediatric sternal fractures.
Methods:
We used ICD codes to search our trauma registry and Hound Dog software to search the hospital data warehouse for all cases of radiologically confirmed sternal fracture in patients <21 years from January 1, 1997 to July 1, 2017. We extracted demographics, mechanism of injury, diagnostic modality, associated injuries, and clinical outcomes.
Results:
We identified 65 children with sternal fractures. 46/65 (71%) were male, with median age 11 years. 34/65 (52%) presented to our emergency department (ED) and the remainder to outpatient clinics. 41/65 (63%) were diagnosed by chest X-ray, 11/65 (17%) by chest CT, 7/65 (11%) by sternal X-ray, and 5/65 (8%) by MRI. Mechanism of injury varied by age. The majority, 50/65 (77%), were isolated injuries and there were no cardiac injuries, aortic injuries or deaths. 18/33 (45%) of those who presented initially to the ED were admitted, and of these 7/18 (39%) had isolated sternal fractures.
Conclusions:
In this series, most sternal fractures were isolated with low morbidity. Sternal fracture alone should not prompt aggressive workup for intrathoracic injuries and stable patients with isolated sternal fractures can be safely followed without admission.
Level Of Evidence:
IV.
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