Role of sonography in the emergency room to diagnose sternal fractures

Abstract

The diagnosis of a sternal fracture is often difficult when the fracture site shows only minimal displacement on conventional radiography. Recently, sonography (US) has been used widely in the emergency room (ER). We investigated the diagnostic performance of US in the ER for the diagnosis of sternal fractures. Thirty-six consecutive patients examined for pain and tenderness in the sternum after blunt chest trauma were enrolled in the study. Antero-posterior and lateral radiographs and sonograms of the sternum were obtained within 24 hours after admission. The 2 imaging modalities were interpreted in a blinded manner and their diagnostic sensitivity and specificity were calculated. The final diagnosis was based on results from the clinical examination, radiographs, and sonograms. Twenty-four of the 36 patients were diagnosed with sternal fractures. The sensitivity and specificity of the plain radiographs were 70.8% (95% CI = 56.0-85.6%) and 75.0% (95% CI = 60.9-89.1%), respectively. In contrast, sonography had a 100% sensitivity and specificity (95% CI = 90.3-100%). US has a higher sensitivity and specificity in diagnosing sternal fractures than conventional radiographs. US should be considered in patients with symptoms suggesting sternal fractures whose radiographs remain indeterminate.