Evaluations of Sternal Fracture Guideline

Presenting complaints of : Anterior chest wall pain Sternal pain Obtain Imaging: Substernal pain CT chest or lateral sternal xray Anterior chest wall ecchymosis

Sternal fracture present on imaging

Consider the wide differential: Rib fractures, CT angiogram chest with contrast. Flail chest, - Include CT angiogram of neck if Vertebral and spine injuries concurrent 1st rib fx. Solid organ injuries Pulmonary contusions Major vascular injuries. Monitor VS 12 lead on initial evaluation and repeat 12 lead in 6 hours

*Echo not recommended as initial screening tool for isolated fx’s nor CK-MB as a diagnostic tool (EAST)

Isolated Sternal Fx with Isolated Sternal Fx with abnormal Sternal Fx with associated normal ECG ECG injuries --Treat associated injuries --IF normal VS, --IF VS unstable or --IF both 12 leads --IF EKG shows heart block, ST IF VS unstable or without signs of acute changes or arrthymias IF EKG shows heart block, ST process and changes or arrthymias --IF pain controlled and -- Admit to telemetry for 24 --IF age < 65 with no hours -- Admit to IMC or ICU cardiac hx -- Obtain Echocardiogram -- Obtain Echocardiogram -- Follow Blunt Cardiac Injury -- Follow Blunt Cardiac Injury DC to home with pain Algorithm Algorithm meds -- Follow pain control and -- Follow pain control and respiratory toilet rec’s from Rib respiratory toilet rec’s from Rib Fracture Management Guideline. Fracture Management Guideline

Indications for Thoracic Surgery Consult: Indications for Thoracic Surgery Consult: Acute fracture Chronic fracture - Unstable fracture - Chronic severe pain - Compression from fractured - Non-union or malunion. segment - Signs of infection: Sternal click, - Severe pain erythema etc. - Cosmetic

10/2016 Approved by Trauma PIPS Committee