Overview
Fracture of the sternal end of the clavicle typically results from direct trauma to the anterior chest wall, often involving complex mechanisms that can lead to significant instability and pain. 1Diagnosis
Clinical Presentation: Severe chest pain, deformity, and limited mobility of the affected shoulder.
Imaging: Detailed three-dimensional CT reconstruction is crucial for assessing fracture morphology and planning surgical intervention. 1
Grading: Specific grading systems are not detailed in the provided abstracts, but imaging helps in categorizing the severity and complexity of the fracture.Management
Surgical Fixation: Anterior sternal plating using low-profile locking titanium plates is recommended for stabilizing fractures, ensuring correct fragment positioning and neutralizing shearing forces. 1
Analgesia: Continuous infusion of local anesthetics (e.g., bupivacaine) and opioids (e.g., morphine) via a periosteally positioned catheter can effectively manage severe pain. 3
Infection Management: Prompt antibiotic therapy for complications such as sternal abscesses, especially when caused by unusual pathogens like BCG strains. 4Special Populations
Pediatrics: No specific details provided in the abstracts regarding pediatric cases.
Elderly: Considerations for surgical intervention may include higher risk of complications; detailed preoperative planning is essential. 1
Comorbidities: Presence of underlying conditions may influence surgical risk and analgesic strategies; careful assessment is necessary. 3Key Recommendations
Utilize detailed three-dimensional CT imaging for preoperative planning in surgical stabilization of sternal fractures to minimize complications. (Evidence: Moderate 1)
Employ anterior sternal plating with low-profile locking titanium plates for optimal stability and alignment of fracture fragments. (Evidence: Moderate 1)
Consider continuous regional analgesia techniques, such as periosteal infusion of bupivacaine and morphine, for managing severe pain post-fracture. (Evidence: Weak 3)
Vigilantly monitor for and treat potential complications like sternal abscesses with appropriate antibiotic therapy, especially in cases with unusual etiologies. (Evidence: Weak 4)References
1 Schulz-Drost S, Oppel P, Grupp S, Schmitt S, Carbon RT, Mauerer A et al.. Surgical fixation of sternal fractures: preoperative planning and a safe surgical technique using locked titanium plates and depth limited drilling. Journal of visualized experiments : JoVE 2015. link
2 Lemaitre J, Koriche Ch, Massard G, Wihlm JM. Manubriosternal disjunction a new approach for surgical repair. Acta chirurgica Belgica 2004. link
3 Duncan MA, McNicholas W, O'Keeffe D, O'Reilly M. Periosteal infusion of bupivacaine/morphine post sternal fracture: a new analgesic technique. Regional anesthesia and pain medicine 2002. link
4 Similä S, Liedes E, Kinnunen P. Sternal abscess as a complication of BCG-revaccination. Tubercle 1988. link90043-8)
5 Hersh JH, Waterfill D, Rutledge J, Harrod MJ, O'Sheal SF, Verdi G et al.. Sternal malformation/vascular dysplasia association. American journal of medical genetics 1985. link