STERNAL FRACTURES IN BLUNT CHEST TRAUMA - A PRACTICAL ALGORITHM FOR MANAGEMENT

A retrospective review of the medical records of blunt trauma patients with sternal fracture admitted to a level 1 trauma center from June 1 990 to June 1993 was undertaken to determine the relationship between sternal fractures and clinically significant myocardial injury, and to assess the usefulness of cardiac evaluation and monitoring in these p atients. Of 33 patients with sternal fracture, 31 were in motor vehicl e crashes and 2 were pedestrians struck, All had Glasgow Coma Scale sc ore = 15. No patient had a severe, life-threatening, associated injury (Abbreviated Injury Score of >3). No electrocardiogram or echocardiog ram showed evidence of acute injury or ischemia. No arrhythmias requir ing treatment were noted. No CPK-MB fraction was >5%. These results sh ow that sternal fracture is not a marker for clinically significant my ocardial injury. The management of sternal fracture patients should be directed toward the treatment of associated injuries. Copyright (C) 1 997 by W.B. Saunders Company.