Cardiovascular injuries associated with sternal fractures

Objective: To find out if the presence of a sternal fracture indicates card iac and aortic injuries and to clarify the difference between a retrosterna l haematoma and widened mediastinum. Design: Retrospective study. Setting: Teaching hospital. Sweden. Subjects: 418 patients with blunt chest trauma of whom 29 had a fractured s ternum (11 with retrosternal haematoma and 18 without) and 389 did not (7 w ith widened mediastinum and 382 without). Main outcome measures: Definition s, risk factors, morbidity, and mortality. Results. Retrosternal haematomas were found adjacent to many fractures and ranged in size from a few mm to 2 cm. They were more common in fractures of the body of sternum. There was no significant difference in the number of associated lesions between patients with sternal fractures with or without a retrosternal haematoma. Conversely, patients with a widened mediastinum h ad a higher injury severity score, longer hospital stay (p < 0.0001), and m ore associated lesions (p < 0.05) than those with retrosternal haematomas. Six patients still had pain 1 month after injury of whom two had injury-rel ated long-term disability because of pain. No serious cardiac or aortic inj uries were detected in this series. The early mortality in our study was 2/ 29 in patients with sternal fractures and 1/7 in patients with widened medi astinum. Conclusions: Sternal fractures are more common than previously reported. An aggressive approach including early operative reduction is recommended eve n for a stable fracture to reduce the overhelming pain. Sternal fracture wi th or without retrosternal heamatoma is not a reliable indicator of cardiac and aortic injuries. while mediastinal widening is still a fairly reliable clue that should indicate further investigation.