Fracture of the sternum, sternum fracture
- 1st rib
- 12th rib
- SternumSternum
- Ribs – sternum – joint
Cause
The most common cause of the fracture is the direct violent impact on the sternum. It is particularly typical for injuries after a car accident. Sports injuries can also be the cause.
The sternum lies unprotected on the rib cage directly under the skin. It is usually deformed to the back. Since the heart lies directly behind the sternum, it can be crushed.
The fracture line usually runs horizontally. The sternum breaks transversely at a virtually predestined location, namely the suture point between the sternum body and the so-called “handle” (Manubrium Sterni). The fracture is very sensitive to pressure.
The unfractured sternum is originally already very sensitive to pain. Due to the pressure to the back, there is respiratory pain. Rib fractures or rib contusions and cartilage fractures of the rib cartilage are also frequently combined with a fracture of the sternum.
Diagnosis
An x-ray of the rib cage in a lateral view is absolutely necessary, since only in this way can the sternum be adequately assessed. If the results of the x-rays are unclear, an ultrasound examination can help in making a diagnosis. A CT (computed tomography) of the sternum may also be necessary in exceptional cases.
In order to rule out a contusion of the heart, an ECG must be taken. A blood sample is also taken to determine cardiac enzymes. In the treatment of sternum fractures, either a conservative or surgical form of treatment can be chosen.
However, depending on the fracture, conservative treatment is usually sufficient. If, on the other hand, the fracture is accompanied by severe pain, breathing problems and displacement of the fragments, it is better to choose the surgical treatment form. If necessary, surgery may also be necessary after conservative treatment because complications have occurred.
A frequent complication requiring surgical treatment is pseudoarthrosis. This is an insufficient bone structure at the fracture site, which leads to a mobile discontinuity of the fracture site. For this reason, it is also known as a false joint.
Conservative therapy: The main aim of conservative therapy is to protect the body and not to put further stress on the fracture site. On the other hand, there is less use of plasters, splints, bandages or the like. Painkillers are also used to relieve the pain.
In addition, targeted and gentle physiotherapy can be used. Despite the mostly conservative therapy, however, inpatient admission is necessary, since the accompanying damage must be excluded. The most important concomitant damages include injury to the lungs, the heart or even cardiac arrhythmia.
The patient must therefore be properly examined, monitored and controlled with appropriate diagnostics, such as X-ray, CT, cardiac echo and ECG. Surgical therapy: In most cases of a sternum fracture, the fractures are straight. These usually do not require surgery and heal by themselves.
However, if a displaced (dislocated) fracture or a multiple fracture is present, surgery is required. A general anaesthetic is first administered before a metal plate is used to fix the fragments together again so that they can grow back together properly. The plate is attached to the bone with screws and can, but does not have to be removed after a few months or years.
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