Blunt Cardiac Injury in Patients with Isolated Sternal Fractures: the Importance of Fracture Grading

Abstract Background: Sternal fractures have long been considered to harbor cardiac injury, although recent studies suggest that the clinical relevance of these injuries is limited. The risk of underlying cardiac injury may be linked to the severity of the fracture. We investigated the relation between the grade of fracture displacement and signs of blunt cardiac injury (BCI) in patients with isolated sternal fractures. Material and Methods: We retrospectively analyzed the available data of 337 patients with sternal fractures, who presented at the Emergency Department of the University Hospital Ghent, Belgium, in a 10-year period. 115 patients had isolated fractures. Fractures were classified according to the grade of displacement. We identified two categories, nondisplaced and displaced fractures. BCI was diagnosed on the basis of electrocardiographic or echocardiographic findings, available in 100% and 96% of patients, respectively. Inhospital arrhythmias were recorded in both patient groups. Results: 32% of patients had BCI. There were 37 patients with displaced fractures (32.1%). These patients showed significantly more signs of BCI (54% vs. 21%; p < 0.01), and had significantly more arrhythmias during hospitalization (23.5% vs. 5.6%; p = 0.017). Conclusion: BCI is common after sternal trauma, and the severity of the fracture is an indicator of possible myo- or pericardial damage. Patients with displaced sternal fractures should be thoroughly investigated for possible BCI.