Clinical significance of isolated sternal fracture.

Background: Isolated sternal fractures (ISF) are uncommon injuries and after exclusion of other concomitant injuries, ISF can be classified as harmless injuries, and can be treated on outpatient basis.

Objective: Based on literature and own experience to make a simple algorithm in the diagnosis and treatment of ISF.

Patients And Methods: Retrospective analysis of medical records of patients who were admitted with ISF to the Clinic for Thoracic Surgery of UCC Sarajevo between January 2000 and January 2010.

Results: A review included 49 patients with ISF. The average age was 52.67 +/- 12.42 (range 21 to 81) years. Age group between 41 and 61 years was significantly more prone to ISF. Male/female ratio was 2.2:1 (34/15). The major cause of the injury, seen in 77.6% (38/49) cases, was an involvement in road traffic accidents (RTAs). Statistically, there is a significant difference (chi2 = 6.74; p = 0.009) in the frequency of occurrence ISF between drivers [55.1% (27/38)] and passengers [22.4% (11/39)]. Of the remaining eleven patients, four ISF were caused by falls at home, and seven by direct violence to the chest either in sport or in a fight. The sternal view radiography was diagnostic in all patients In most patients [83.7% (41/49)] the enzymatic values were elevated. ECGs were recorded in all cases, of which only 12.2% (6/49) had an abnormality. The average duration of hospitalization was 3.57 +/- 2.01 (range 1 to 7) days. It should be noted that 34.7% of patients were discharged in less than 24h and 73.5% were discharged in under 48h. Commonly used analgesic, metamizol, was applied in 98.0% (48/49) of cases. The combination of tramadol and metamizol was given in 63.3% (32/49) of patients.

Conclusion: Established results support the view that patients with ISF and no abnormality in ECG and cardiac enzymes during the early hours after injury are expected to have a benign course and can be discharged home within the first 24 to 48 hours. Proposed algorithm can be of assistance In making such decisions.