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This article has been corrected. See "Erratum: Traumatic Sternal Fracture: Incidence, Causes, and CT Features" in Volume 72 on page 439.
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Kim, Kim, Jou, Han, and Bae: Traumatic Sternal Fracture: Incidence, Causes, and CT Features
Chest Radiology

Journal of the Korean Society of Radiology 2015; 72(5): 305-312.

Published online: 29 April 2015

DOI: https://doi.org/10.3348/jksr.2015.72.5.305

Traumatic Sternal Fracture: Incidence, Causes, and CT Features

Hyo Weon Kim, MD, Young Tong Kim, MD, Sung Shick Jou, MD, Jong Kyu Han, MD, Won Kyung Bae, MD

Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea.

Corresponding author: Young Tong Kim, MD. Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 330-721, Korea. Tel. 82-41-570-3513, Fax. 82-41-579-9026, ytokim@schmc.ac.kr

Received 29 July 2014       Accepted 22 October 2014

Copyright © 2015 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the incidence of sternal fracture due to trauma, the CT features of sternal fractures, and the hospitalization period.

Materials and Methods

The medical records and CT images of 755 patients who suffered trauma from January 2012 to August 2013 were analyzed retrospectively. We compared the incidence of sternal fracture due to various traumatic causes. We evaluated the location and shape of the sternal fracture on CT scans and the relationship between a sternal fracture and the hospitalization period.

Results

The incidence of sternal fracture was 9.27% (70/755) in all patients; 11.7% (53/453) due to a traffic accident (TA), and 5.63% (17/302) due to other causes. TA was the most frequent cause (75.71%) of a sternal fracture, fracture incidences after a TA differed by traumatic cause (p < 0.05). Among sternal fractures, the body was the most commonly involved (68.57%), one wall was limited (32.85%), and anteroposterior length increased (7.14%). Body fractures involving two or more segments included 33.33% of the cases. The hospitalization period was not related with sternal fracture (p = 0.30).

Conclusion

fracture was more frequent after a TA than due to other causes. Fracture incidences after a TA depended on the traumatic causes. Involvement of two or more segments and one wall-limitation were common among sternal fractures. Sternal fractures occurred even in slightly injured patients.

Keywords: Sternum, Fracture, Trauma, Incidence, Computed Tomography

Figures and Tables

Fig. 1

Fracture of sternal body in a 35-year-old man who was struck by heavy object. Sagittal image shows a comminuted fracture involving the mid and lower portion of the sternal body. There is a peristernal hematoma (arrowhead) at the retrosternal area.

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Fig. 2

Multiple sternal fractures in a 38-year-old woman with driver accident. Sagittal CT scan and curved coronal images show multiple fractures (arrows) in the manubrium and body of the sternum.

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Fig. 3

Multiple fractures in sternal manubrium and body in a 69-year-old man with driver accident. On sagittal image, the anteroposterior length is increased with fractures (arrowheads) at the upper one-third of the sternal body. There are also focal cortical defects at the lower portion of the manubrium (curved arrow) and at the anterior wall of the lower body (open arrow). Volume rending and curved coronal images show two or more segmental fractures at the upper and lower portion of the sternal body (open arrowheads). Volume rendering and curved coronal images are useful for diagnosing sternal fracture, when a cortical defect of the sternum is only seen without displacement on axial and sagittal images.

jksr-72-305-g003
Fig. 4

Fracture of sternal manubrium in a 43-year-old woman with driver accident.

A. Sagittal CT scan shows a focal defect (arrow) at the anterior cortex of the manubrium and a focal radiolucency in the adjacent medulla. Volume rendering image of the sternum shows one wall-limited fracture (open arrowhead) of the manubrium.
B. Bone scintigraphy obtained 10 days after CT scan shows a hot uptake (open arrowhead) in the inferior portion of the manubrium.
jksr-72-305-g004
Table 1

Sternal Fracture Incidence According to Traumatic Causes

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Traumatic Cause Fracture Incidence (%) p Value
Traffic accident (n = 453) 53 (11.70) <0.05
 Bike rider accident (n = 14) 0 (0)
 Car accident (n = 233)* 43 (18.45)
  Driver (n = 143)/passenger (n = 84) 34/9
 Pedestrian (n = 122) 6 (4.92)
 Motorcycle (n = 68) 4 (5.88)
 Bus passenger (n = 5) 0 (0)
 Cultivator (n = 11) 0 (0)
Non-traffic accident (n = 302) 17 (5.63) 0.31
 Crushing (n = 15) 1 (6.67)
 Fall from height (n = 101) 3 (2.97)
 Physical fight (n = 36) 3 (8.33)
 Rolling down stair (n = 23) 2 (8.69)
 Slip (n = 79) 3 (3.80)
 Strike (n = 39) 5 (12.80)
 Stab wound (n = 9) 0 (0)

*No medical record about location of 6 patients

Table 2

CT Findings of 70 Patients with Sternal Fracture

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Traumatic Cause One Wall-Limited Fracture (23) Fracture with Increased AP Length (5) Peristernal Hematoma (52)
Traffic accident (53)
 Car accident (43) 14 3 32
  Driver (34)/passenger (9) 11/3 3/0 26/6
 Pedestrian (6) 1 1 4
 Motorcycle (4) 2 0 4
Non-traffic accident (17)
 Crushing (1) 1 0 1
 Fall from height (3) 1 1 2
 Physical fight (3) 2 0 1
 Rolling down stair (2) 1 0 1
 Slip (3) 0 0 3
 Strike (5) 1 0 4

Parenthesis mean number of patients.

AP = anteroposterior

Table 3

Clinical Outcome of Sternal Fracture vs. Non-Fracture Groups

jksr-72-305-i003
Sternal Fracture (%) Non-Fracture (%)
(n = 685)
Total (n = 70) Isolated (n = 16) Combined (n = 54)
Discharge at the day of exam 24.29 56.25 14.81 33.43
Hospitalization period ≤7 days 7.14 12.50 5.56 7.74
Hospitalization period ≤1 month 30.00 18.75 33.33 30.80
Hospitalization period >1 month 20.00 0 25.93 9.05
Expire 5.71 0 7.41 4.82
Self discharge or transfer to other hospital 12.86 12.50 12.96 14.16

Parenthesis mean number of patients. Isolated: isolated sternal fracture. Combined: sternal fracture with other fractures

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