Isolated sternal fracture--a benign condition?

BACKGROUND Fractures of the sternum may be associated with major injuries to thoracic organs, with serious consequences. OBJECTIVE To assess the hospital course of patients diagnosed with isolated sternal fracture. METHODS We reviewed 55 medical records of patients who were admitted with isolated sternal fracture to the emergency department during the period January 1990 through August 1999. RESULTS Fifty-one patients were involved in motor vehicle accidents, and 4 sustained the injury as the result of a fall. Lateral chest X-ray upon admission was diagnostic in the majority of these patients (n = 53). Electrocardiography (n = 52) was abnormal in four patients--old myocardial infarction (n = 1), non-specific ST-T changes (n = 3). Cardiac enzymes (creatine-kinase-MB, n = 42) were pathologically elevated in five patients. Echocardiography, performed in patients with ECG abnormalities and/or elevated myocardial enzymes (n = 7), was normal in these patients as well as in another 18 patients. There were no intensive care unit admissions or arrhythmias during the hospital stay, which ranged from 6 hours to 6 days (mean 2.3 +/- 1.3 days, median 2 days). CONCLUSION Our findings support the view that patients with isolated sternal fracture and no abnormality in ECG and cardiac enzymes during the early hours after injury are expected to have a benign course and can be discharged home from the emergency room within the first 24 hours.