Sternal fracture--a modern review.

Abstract

Sternal fractures have long been regarded as a potentially serious injury or at least a marker thereof. A retrospective review presented here challenges this premise and questions the current management. Sternal injuries have been assessed since the 1860's when they were recorded to be both rare and associated with severe trauma (Guilt 1864). Over the next hundred years the incidence increased and a strong association with road traffic accidents (RTAs) became apparent (Helal, 1964). Indeed, by the early 1970's such was the preponderance of patients whose fracture was caused by a restraint that the injury was included in the 'Safety-belt syndrome' (Michelinakis, 1971). From the mid-point of the century evidence demonstrated that patients ought to be admitted and closely observed suggestions range from simple electrocardiogram to routine use of isotope scans and 2-D echocardiogram (Mayfield, 1984) in order that cardiac contusion and other complications should not be missed. This represents the core of the policy currently followed in the United Kingdom. The seat-belt law has recently been extended and hence a further increase in the frequency of this injury could reasonably be expected. A review of our cases was undertaken to see if these commonly held assumptions are true and whether a change in management is now required.