Three Part Question
In [an adult with an isolated sternal fracture following a road traffic accident] is [routine admission] warranted to [detect possible cardiac events]
A 30 year old man presents having been involved in a front end collision while driving a car at 40mph. He is found to have sternal tenderness and an x-ray reveals a fracture. There are no other significant injuries.
Medline 1966 to 12/99 using the OVID interface.
[exp accidents traffic OR traffic ti.ab.sh] AND [exp sternum OR sternum ti.ab.sh] AND [exp fractures OR fractures.ti.ab.sh] LIMIT to human and English language
6 papers of which one was irelevant and 2 were of insufficient quality.
|Author, date and country
||Study type (level of evidence)
|Brookes et al|
|272 fractures over 6.5 years, 124 isolated fractures, 93% from RTA's||Retrospectice review||Accident details, fracture grade, cardiac sequalae||Isolated fracture minimal complications, arrythmias seen with age>65, IHD or digoxin||Possible missed fracrtures, retrospective design|
|Hills et al|
|172 fractures over 6.5 years, 89% from RTA's||Prospective cohort study||Associated injuries||No clear association with intrathoracic injury. Slight increase in thoracic spine injury||Data collection uncertain, no uniform cardiac screen|
|Bu'Lock et al|
|63 patients with central chest trauma, 45 seat belt related||Prospective cohort study||ECG findings and cardiac enzymes, echocardiography||None of these needed treatment and no adverse effects seen. ECG and enzymes correlated poorly with these findings. 25% of isolated seat belt injuries had pericardial effusion||Small numbers, not all had fractures|
Studies are not of the best quality. More rigorous prospective studies with larger numbers are required to make definite recommendations. Isolated sternal fractures caused by seat belts with no associated injuries and normal electrocardiography and chest radiology appear to be benign and can be discharged provided pain not severe. The situation with sternal fractures caused by other mechanisms is unclear.
Clinical Bottom Line
Patients with isolated sternal fractures caused by seat belts who have a normal electrocardiography, chest radiography, and stable vital signs can be discharged.
- Brookes JG, Dunn RJ, Rogers IR. Sternal fractures: a retrospective analysis of 272 cases. J Trauma - Injury Infection & Critical Care 1993;35(1):46-54
- Hills MW, Delprado AM, Deane SA. Sternal fractures associated injuries and management. J Trauma - Injury Infection & Critical Care 1993;35(1):55-60
- Bu'Lock FA, Prothero A, Shaw C, Parry A, Dodds CA, Keenan J, Forfar JC. Cardiac involvement in seatbelt - related and direct sternal trauma: a prospective study and management implications. Eur Heart J 1994;15(12):1621-1627