Sternal Fracture
Typically seen in victims of head-on MVCs, either from anterior chest striking
steering wheel or from diagonal part of seat belt restraining upper sternum.
SYMPTOMS/EXAM
■ Anterior chest pain, often pleuritic
■ Point tenderness
■ Palpable deformity
DIAGNOSIS
■ A sternal fracture is usually evident on a lateral CXR, but only if you are
looking for it. The PA or AP film is often normal.
■ The incidence of blunt myocardial injury (BMI) with sternal fractures is
1.5–6%.
■ Mortality of MVC patients with sternal fractures is 0.7%.
■ Patients with sternal fracture, nl vitals, and nl EKG should be on cardiac
monitor for 4–6 hours and may need repeat EKG in 6 hours to rule out
blunt myocardial injury, although recent evidence shows that sternal frac-
tures are not strongly associated with significant BMI.
TREATMENT
Pain control
Pulmonary Contusion
MECHANISMS
■ Compression-decompression injury of lung parenchyma
■ The uninjured lung may also develop edema in response to the reflex
shunting of blood flow.
SYMPTOMS/EXAM
■ Hemoptysis is present in up to 50% of pulmonary contusions.
■ Other findings include dyspnea, tachypnea, tachycardia.
■ Chest wall bruising or tenderness
DIAGNOSIS
■ CXR may show contusions (opaque patches of lung) within minutes to six
hours.
■ Appearance on CXR is usually milder than actual extent of damage, which
may be better visualized on CT.
TREATMENT
■ Respiratory support to prevent hypoxia
■ Percent of involved lung may help determine when mechanical ventila-
tion is needed: Unlikely for <18% (one lobe), consider in patients with
28% contusion.
■ Severe pulmonary contusions may require high-frequency oscillation
(kinetic therapy), turning the patient to place uninjured lung in depen-
dant position to match perfusion and ventilation, and pressure-controlled
inverse-ratio ventilation.
TRAUMARestrained passengers are
much more likely to have
sternal fractures than
unrestrained occupants.