Surgical Treatment of Sternal Fracture: Case Report and Literature Review

Abstract

Sternal fractures are uncommon thoracic trauma that can ensue in isolation or conjunction with other organ injuries, implying more significant morbidity and mortality. These fractures result from diverse aetiological mechanisms, some of which may provoke minor chest wall issues, while others can have deadly outcomes. The sternal fracture’s primary aetiological culprits are direct impact and the upper thoracic region’s compression. Studies reveal that traumatic sternum fractures occur in 8-18% of blunt thoracic and polytrauma victims, whereas they are unusual in open trauma. This report aims to outline the case of a 54-year-old Caucasian male with hypertension and an alcohol consumption history who sustained a direct impact on the anterior thorax after a traffic accident. He experienced severe pain that worsened with movement and coughing, and breathing difficulty. We noticed a painful haematoma and depression with bony crepitus at the sternal body level. Abdominal-pelvic echography indicated no intraabdominal lesions and showed pleural effusion in the left lung base, while thoracic X-rays (lateral and anteroposterior view) and chest computerized tomography (CT) scan exhibited mid-sternum segment displaced fracture and haemothorax. We diagnosed a mid-sternum completely displaced overlapping fracture and a traumatic left haemothorax. Therefore, urgent surgical intervention was required. We performed a minimal-lower pleurotomy and internal fixation to address the fracture. His post-operative recovery was satisfactory. Although various authors advocate X-rays as an effective diagnostic means for sternal fractures, CT uncovers overlooked radiography abnormalities; therefore, CT must be considered in patients’ initial assessment. While most sternal fractures can be treated conservatively, surgery is feasible in displaced fractures.