Sternal Fracture in Children: Diagnosis by Ultrasonography

Abstract

Because of its subcutaneous location, the sternum can be examined sonographically using a linear scanner. We report about two children who experienced blunt chest trauma. Anterior–posterior chest X-rays were normal. Ultrasonic imaging confirmed a fracture of the sternum with dorsal displacement of the distal fragment (by 0.97 cm) in the first child and a transverse fracture of the body of the sternum without displacement in the second child. In both children, pericardial effusion was excluded by sonography. The displaced fracture of the sternum was confirmed by magnetic resonance imaging (MRI), which ruled out concomitant injuries of the soft tissues adjacent to the sternum. Both sternum fractures were managed nonoperatively. These cases serve to emphasize the importance of sonography that represents an ionizing radiation free, noninvasive, efficient, and safe imaging modality to diagnose fractures of the sternum in children while also enabling the assessment of the pericardium.

14-year-old boy • aching midsternal pain following a basketball injury • worsening pain with direct pressure and when the patient sneezed • Dx?

“…2,3 They are typically transverse and localized, with 70% of fractures occurring in the mid-body and 17.6% at the manubriosternal joint. 1,3,6 ❚ Athletes with a sternal fracture typically present as our patient did, with a history of blunt force trauma to the chest and with pain and tenderness over the anterior midline of the chest that increases with respiration or movement. 1 A physical examination that includes chest palpation and auscultation of the heart and lungs must be performed to rule out damage to intrathoracic structures and assess the patient's cardiac and pulmonary stability.…”

“…1,3 These fractures are even more unusual in children due to the increased elasticity of their chest walls. [4][5][6] Thus, it takes a significant amount of force for a child's sternum to fracture. While isolated sternum fractures can occur, two-thirds of sternum fractures are nonisolated and are associated with injuries to surrounding structures (including the heart, lungs, and vasculature) or fractures of the ribs and spine.…”

“…3,4 Initial imaging should include AP and lateral chest radiographs because any displacement will occur in the sagittal plane. 1,2,[4][5][6] If the radiograph shows no clear pathology, follow up with computed tomography, ultrasound, MRI, or technetium bone scans to gain additional information. 1 Diagnosis of sternal fractures is especially difficult in children due to the presence of ossification centers for bone growth, which may be misinterpreted as a sternal fracture in the absence of a proper understanding of sternal development.…”

A Rare Injury in Children: Sternum Fractures

“…There are clinics that often use ultrasonography, if there is a suspicion of fracture. 9 Since, there were not enough radiologists, ultrasonography could not be routinely used. Pericardial tamponade and mediastinal hematoma were observed in patients with sternum fractures.…”

POCUS Diagnosis of Sternal Fractures in Children without Direct Trauma—A Case Series

“…Ultrasound examination of the sternum is well-established and has proven to be more sensitive than X-ray or even CT for diagnostic imaging of sternal fractures [ 5 , 6 , 7 , 8 ]. With the progressive use of point-of-care ultrasound (POCUS), some case reports have emerged documenting sternal fractures after low-energy trauma or even in the absence of direct trauma to the sternum or thorax [ 9 , 10 , 11 , 12 ].…”