Traumatic Sternal Fractures can be Safely Treated Conservatively - A 13-Year Retrospective Cohort Study

Traumatic sternal fractures are rare injuries with little evidence supporting the best treatment strategy. This study assessed treatment outcomes from our level-I trauma centre.

A retrospective cohort study was conducted, including all sternal fracture patients admitted to our level-I trauma centre between 2007 and 2019. Patients with sternal fractures due to cardiopulmonary resuscitation, patients <16 years, patients who died during initial hospital stay, and patients lost to follow-up were excluded from analysis.

In 13 years, 355 patients with traumatic sternal fractures were admitted, corresponding to 2% of all trauma patients. 262 patients were included in analysis. Mean age was 52 years and 71% of patients were male. Mean ISS was 19 (range 4-66). The majority of sternal fractures was located in the sternal body. Six patients (2%) underwent primary sternal fixation. Treatment failure occurred in three patients (1%) and was significantly higher in the surgical treatment group (p=0.001). There was no difference in treatment failure between patients with and without concomitant spinal fractures.

Conservative treatment is safe and effective for traumatic sternal fractures. Surgical treatment should be reserved for rare cases, such as imminent respiratory failure or debilitating symptomatic non-union.