Traumatic sternal fractures: a narrative review

OBJECTIVE: Traumatic sternal fractures are injuries most commonly resulting from a direct blow to the anterior chest wall or forced deceleration. The purpose of this review is to define the clinical significance of these injuries, outline their initial evaluation and work up, and review current treatment strategies available and their outcomes. BACKGROUND: The diagnosis of traumatic sternal fractures has seen a recent rise, largely due to the increased access to computed tomography (CT) scan. Currently, there are no published guidelines to make recommendations on operative fixation for sternal fractures. This is probably related to the lack of evidence in published literature along with patient heterogeneity. METHODS: We conducted a non-systematic review of the English literature published from January 2000 to December 2020, including meta-analyses, systematic reviews, case series and case reports regarding the diagnosis, treatment, and complications of traumatic sternal fractures. We critically analyzed the available evidence to provide an overview of the treatment and clinical outcomes of traumatic sternal fractures. CONCLUSION: Isolated sternal fractures are commonly benign injuries that can be managed conservatively in an outpatient setting. Polytrauma patients with sternal fractures should be carefully screened for possible associated injuries. Surgical stabilization of sternal fractures is feasible and safe, and should be considered in unstable fractures, severe displacement, symptomatic malunion or non-union.