One car accident Injury almost exclusive to drivers is the sternal fracture. This is a fracture involving one of three bones that are semi-fused together. It is usually the middle bone, the body of the sternum, which is fractured. It was once believed that the mortality rate was as high as 45 percent. Recent research says the mortality rate of sternal fractures is a low 1 percent. About 1.5 percent depress into the heart causing a cardiac rhythm disturbance that can be fatal if not properly treated.
The cause of sternal fractures is blunt trauma of the chest. It can be found in weight lifters, golfers and especially in motor vehicle accidents, which causes 60-90 percent of all sternal fractures. There are even cases of spontaneous fractures in people who have severe osteoporosis. Most of these patients are elderly women who have very little bone density. A few people can get a sternal fracture after having survived CPR that was too vigorous.
When it comes to motor vehicle accidents and sternal fractures, many of the incidents happened in older vehicles that had no airbags and in those who were not restrained. The lack of restraint resulted in ejection from the vehicle and multiple fractures, including sternal fractures. Others were partially ejected, leading to dashboard injuries and sternal fractures. Pedestrians struck by motor vehicles are at risk for sternal fracture as well.
Death from sternal fractures is uncommon but can occur due to disruption of the aorta, contusion of the heart and bruising of the lungs. The sternum protects these areas and, when fractured, injuries can occur. Other people with sternal injuries die from unrelated injuries such as head injuries and abdominal injuries. Sternal fractures happen in women slightly more often than in men. Those over 50 years are more likely to sustain a sternal fracture because of inelasticity of their chest walls.
Doctors diagnose a sternal fracture based on how the accident occurred. If there was direct trauma to the chest wall, an x-ray can be done to reveal the presence of the fracture. People with spinal injuries tend also to have sternal injuries so if one is seen there needs to be a high index of suspicion for the other. This is due to severe hyperflexion injuries of the upper torso. People with these injuries complain of pain in the sternal area and about 15-20 percent of patients are short of breath. There may be a pulmonary or cardiac contusion underneath the fracture, which can lead to changes in the blood pressure or heart rate.
In examining a patient with sternal fracture, the doctor needs to be aware of the possibility of rib fractures, pneumothorax, flail chest, bruising of the lungs, heart arrhythmias, bleeding around the heart and within the pericardial sac (the sac around the heart) and other blood vessel injury. About 40-55 percent of sternal fracture patients have soft tissue swelling or bruising.
In one study, almost 13,000 patients were studied, of whom 17.6 percent were motor vehicle accidents. There were 172 sternal fractures occurring 89 percent of the time from a motor vehicle accident. More victims were over fifty and more were women. More seatbelt wearers suffered sternal fractures than those who didn’t wear seat belts.
The treatment of sternal fractures can be conservative, with no particular treatment besides pain control. In some cases, surgical repair with plates is deemed necessary.