Treatment of Sternal Fracture

Initial Assessment and Risk Stratification

The American College of Radiology recommends obtaining baseline ECG and cardiac troponin levels immediately in all patients with sternal fractures, as patients with normal ECG and normal cardiac troponins can be safely discharged without prolonged observation, with a low probability for cardiac blunt trauma 1, 2, 3
The American College of Radiology suggests that CT chest without IV contrast accurately detects sternal fractures using sagittal and 3-D reconstructions and should be the imaging modality of choice, with a high degree of accuracy 1, 4
Patients with ECG changes or rising troponin levels should be monitored for arrhythmias and myocardial contusion, as approximately 6% of sternal fracture patients develop these complications, with a moderate level of evidence 1, 2
Echocardiography is not recommended for isolated sternal fractures when ECG and troponins are normal, with a low level of evidence 1, 2

The American College of Rheumatology recommends providing appropriate analgesics for pain control, tailored to patient comorbidities, and beginning early mobilization and physical training as soon as pain allows, with a moderate level of evidence 5, 6
Range-of-motion exercises should start within the first postoperative days, including shoulder, elbow, wrist, and hand motion, with a moderate level of evidence 6
Restrict above-chest-level activities until fracture healing is evident, with a low level of evidence 6

The American College of Rheumatology recommends assessing for underlying osteoporosis and considering calcium and vitamin D supplementation, with a moderate level of evidence 6, 7, 8
Perform fall risk assessment as part of overall management, with a low level of evidence 5
Monitor for secondary complications such as deep vein thrombosis in less mobile patients, with a low level of evidence 5
Consider multidisciplinary geriatric input to address age-related factors affecting recovery, with a low level of evidence 5