Sternal fractures: New perspectives

Abstract

Acute sternal fractures occur in the setting of severe deceleration. The authors propose that the displacement in a sternal fracture can point to the mechanism and thus to associated injuries that should be considered. Stress fractures of the sternum follow a predictable pattern that mirrors the acute indirect sternal injury, i.e., hyperflexion of the thoracic cupula. The authors propose that this thoracic cupula acts as a unit in hyperflexion of the upper thoracic spine and signals severe deceleration with likely posterior shears of aorta, spine, cord, and lungs. The lower sternal depression, conversely, points toward more anterior compression with heart and anterior lung at risk. Thus, the direction of the sternal fracture displacement yields valuable information about the mechanics of injury. Including the sternum on lateral C-spine and T-spine films fills an important gap in our understanding the mechanism of thoracic trauma.