Sternal fractures and their management

Abstract

Sternal fractures are predominantly associated with deceleration injuries and blunt anterior chest trauma. Sternal trauma must be carefully evaluated by monitoring of vital parameters and it is of paramount importance that concomitant injuries are excluded. Nevertheless, routine admission of patients with isolated sternal fractures for observation is still common in today's practice, which is often unnecessary. This article aims to describe the prognosis, the recommended assessment and management of patients with sternal fractures, to help clinicians make an evidence-based judgment regarding the need for hospitalization.

Bilateral Subpectoral Interfascial Plane Catheters for Analgesia for Sternal Fractures

“…Apprehension due to pain can predispose patients to chest infections because the sternum is involved in respiration and coughing. 1 For approximately two thirds of patients with sternal fractures, analgesia alone will suffice. 1 However, conventional treatment options like systemic opioids are associated with adverse effects like sedation, delirium, nausea, vomiting, and respiratory depression.…”

“…This can predispose patients to chest infections due to poor respiratory compliance. 1 The serratus interfascial plane (SIP) block has been described for pain from rib fractures or chest drain insertions in difficult to wean intensive care patients. 2 There have been no reports in literature on the use of bilateral SIP blocks in sternal fractures.…”

Periosteal Infusion of Local Anesthetics as an Alternative to Bilateral Subpectoral Interfascial Plane Catheters in Patients With Sternal Fractures

“…Most studies comparing both techniques for arthroscopic shoulder surgery show significantly lower pain scores, opiate use, and nausea following CSANB resolution. 5,6 Pain scores were significantly higher in postanesthesia care unit but tended to settle after 2 hours postoperatively. 5,6 As Tran et al 1 noted, this pain is most likely mediated through the lateral pectoral or the subscapular nerves and seems to correlate chronologically with resolution of capsular distension by arthroscopic fluid.…”

“…6 We believe that just like the sternal periosteal local anesthetic infusion the SIP block can be a useful technique to have in the anesthetic armamentarium and has its own benefits to justify its use. We agree that a study is warranted to compare these 2 simple and effective techniques in the management of sternal fractures.…”

Delayed complications and functional outcome of isolated sternal fracture after emergency department discharge: a prospective, multicentre cohort study

“…3,5 Knowledge regarding the clinical significance of isolated sternal fracture has evolved, and many studies have demonstrated that patients with this injury can safely be discharged from the emergency department (ED) after investigation. [6][7][8][9] A retrospective cohort study found that cardiac complications were present in 0.8% of isolated sternal fracture cases. 5 Clinically significant cardiac complications associated with isolated sternal fracture have been shown to be essentially nonexistent when an initial electrocardiogram and cardiac biomarker levels are normal.…”