The sternal fracture is a sternal fracture (breastbone), located in the middle of the chest. Injuries, which occur in 5-8% of people who experience significant blunt trauma, may occur in a vehicle accident, when the chest is still moving on the steering wheel or dash or injured by a seat belt. Cardiopulmonary resuscitation, commonly known as CPR, has also been known to cause thoracic injury, including chest fractures and ribs. Sternal fractures may also occur as pathologic fractures, in people who have weakened bones in their breastbone, due to other disease processes. A sternal fracture can disturb breathing by making it more painful; However, its major significance is that it can indicate a serious internal injury, especially in the heart and lungs.
Video Sternal fracture
Cause
Vehicle crashes are a common cause of sternal fractures; injury is estimated to occur about 3% of car accidents. The chest of a driver who does not wear a seat belt can hit the steering wheel, and the shoulder belt component may injure the chest if worn without a wipe component. It is quite common for the breastbone to be injured by a seatbelt that is included in the 'seat belt' syndrome, the injury pattern caused by the seat belt in a vehicle accident.
Injuries can also occur when the chest suddenly bend, without any impact. In the case of injuries sustained during CPR, the most common injuries were rib fractures, with literature showing an incidence of between 13% and 97%, and a sternal fracture, with an incidence of between 1% and 43%. In addition, injury to the sternum can be made more likely if there is another disease process in place that has weakened the bone - in this case, the fracture that occurs is called a pathologic fracture.
Maps Sternal fracture
Related injuries
Due to the high frequency of related injuries, doctors are taught to suspect that patients have some severe injuries if a sternum fracture is present. Sternal fractures are commonly associated with injury to the heart and lungs; if a person is injured with sufficient strength for a sternal fracture, injuries such as myocardial contusions and possible lung. Other related injuries that may occur include damage to blood vessels in the chest, myocardial rupture, head and abdominal injuries, chest injuries, and vertebral fractures. A sternal fracture may also accompany rib fractures and is a fairly high-energy injury to cause robchial tears (breakage of the bronchioles). They can inhibit breathing. Because of related injury, mortality rates for people with high sternal fractures, estimated at 25-45%. However, when a sternal fracture occurs in isolation, the results are excellent.
There is controversy over the question of whether the presence of a sternal fracture is an indication of a heart injury.
Signs and symptoms
Signs and symptoms include crepitus (crackling sound made when the fractured end of the bone rubbing), pain, tenderness, bruising, and swelling above the site of the fracture. This fracture may appear to move while the person is breathing, and may bend or deform, potentially forming a "step" at the crossing of the broken bone end which can be detected by palpation. Such related injuries to the heart can cause symptoms such as abnormalities seen in electrocardiograms.
The upper and middle sternum are the most likely to be broken, but most of the sternal fractures occur below the sternal angle.
Assessment and care
Chest X-rays are taken in people with chest trauma and symptoms of a sternal fracture, and this can be followed by a CT scan. Since X-rays taken from the front may escape from injury, they are taken from the side as well.
Management involves treating related injuries; people with sternal fractures but no other injuries need not be hospitalized. However, since it is common for a cardiac injury to accompany a sternal fracture, the function of the heart is monitored with an electrocardiogram. Fractures that are very painful or very out of place may be operated to repair bone fragments into place, but in most cases, treatment consists primarily of relieving pain and restricting movement. This fracture can interfere with breathing, requires tracheal intubation and mechanical ventilation.
Patients who experience pathologic fractures will be investigated for underlying disease causes, if unknown. Treatment of underlying diseases, such as chemotherapy if indicated for bone cancer, may help correct the pain of sternal fractures.
History
In 1864, E. Guilt published a handbook that recorded a sternal fracture as a rare injury found in severe trauma. Injuries are becoming more common with the introduction and extent of car use and increased traffic accidents. An increase in sternal fracture has also been seen with an increase in the legal frequency that requires seat belts to be imposed.
See also
- Pulmonary hygiene
References
Source of the article : Wikipedia
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