Brief ReportsEchocardiogram in sternal fracture☆,☆☆
Section snippets
Methods
Between May 1987 and April 1998, 50 consecutive patients were admitted to our department with the diagnosis of SF. Data regarding the mechanism of injury, signs and symptoms, as well as associated injuries and diagnostic workup were recorded.
SF was confirmed by chest and lateral sternal radiographs. Cardiac evaluation included a 12-lead electrocardiogram (ECG), serum creatine kinase (CK) and MB isoenzyme (CK-MB) level. Cross-chest echocardiogram (ECHO) was performed whenever abnormal ECG or
Results
The records of 50 patients, 24 males and 26 females were evaluated. The mean age was 45.3 (range 18-82) years. No deaths were recorded among all patients. The leading cause of injury was road accidents (Table 1), followed by falls from height, domestic injury, and accidents at work.Mechanism of Injury No. % Automobile accident 39 78 Auto versus pedestrians 4 8 Work accident 2 4 Domestic accident 2 4 Fall from height 2 4 Unknown 1 2
Twenty-eight (56%) patients suffered various associated injuries
Discussion
The incidence of myocardial contusion after blunt chest trauma has been reported to be 62% and more,7 however the definition of myocardial contusion has been often debated. There is lack of definition as for what abnormal tests should be regarded as cardiac complication.3 In addition, there is variability as to the level of CK-MB that is considered abnormal as well as the determination of abnormal ECG or ECHO studies.
ECG, CK and CK-MB enzymes are the first step in the evaluation of myocardial
Conclusion
SF may be associated with myocardial contusion even in patients without associated significant injuries. The ECHO can show myocardial motion abnormality that would otherwise not be detected by ECG or CK-MB enzyme studies. However, pericardial effusion without any other abnormal finding is a benign phenomenon and is not associated with subsequent cardiac complications.
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Cited by (22)
Comment on: Perforation of the right cardiac ventricle as a late complication of a displaced sternal fracture following blunt trauma
2022, American Journal of Emergency MedicineSevere cardiac trauma or myocardial ischemia? Pitfalls of polytrauma treatment in patients with ST-elevation after blunt chest trauma
2015, Annals of Medicine and SurgeryCitation Excerpt :A meta-analysis by Maenza et al. showed a concordance between important cardiac complications and abnormal ECG findings [16]. Previous studies report a high likelihood of abnormal FAST results, ECG findings, and myocardial markers in patients with cardiac injuries secondary to chest trauma [17,18]. Witnesses reported that the decedent drove into a pole under unobstructed road conditions.
Blunt cardiac injury in critically ill trauma patients: A single centre experience
2015, InjuryCitation Excerpt :No patients sustained sternal fractures in isolated. Other studies have also failed to demonstrate association with isolated sternal fractures and BCI [13–15]. Injury to any skeletal muscle, kidneys, brain or liver causes release of creatine phosphokinase (CPK).
Isolated sternal fractures treated on an outpatient basis
2013, American Journal of Emergency MedicineCitation Excerpt :However, an increased myocardial enzyme level does not necessarily pinpoint a myocardial injury [1,5]. In the same direction, ECG is also unreliable in detecting cardiac injury in sternal fracture patients [1,5]. Furthermore, the detection of pericardial fluid in US was not associated with an adverse outcome, whereas isoenzymes and ECG abnormalities were not correlated with US findings [5].
Traumatic sternal fractures: a narrative review
2021, MediastinumTraumatic sternal injury in patients with rib fracture: A single-center experience
2019, International Journal of Critical Illness and Injury Science
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Address reprint requests to Yaron Wiener, MD, Dept. of Surgery “B,” Assaf Harofeh Medical Center, Zeriffin, Israel 70300. E-mail: [email protected]
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