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Echocardiogram in sternal fracture,☆☆

https://doi.org/10.1053/ajem.2001.24463Get rights and content

Abstract

We reviewed the records of 50 consecutive patients presenting with sternal fracture after blunt chest trauma. The relationships between electrocardiogram, creatine kinase MB isoenzyme and echocardiogram (ECHO) were assessed in reference to myocardial contusion. Eleven patients (22%) had 1 or more abnormal cardiac tests but only 3 (6%) had clinically symptomatic myocardial contusion. Seven (22.5%) out of 31 ECHO studies revealed pericardial effusion which was not associated with the severity of all other associated injuries. The incidence of an abnormal ECHO study in patients with isolated sternal fracture was similar to that of patients who suffered multiple injuries. In 5 patients with pericardial effusion, this finding was not associated with any other abnormal tests and was regarded as of no clinical cardiac significance. On the other hand, a myocardial contusion was shown by ECHO examination only while echocardiogram and creatine kinase MB tests remained normal in that patient. We suggest that the ECHO should be used as a diagnostic and triage tool in every patient with sternal fracture associated with other injuries. However, patients with “benign” pericardial effusion can be discharged as soon as their medical condition improves regardless of other associated injuries. (Am J Emerg Med 2001;19:403-405. Copyright © 2001 by W.B. Saunders Company)

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

Mechanism of InjuryNo.%
Automobile accident3978
Auto versus pedestrians48
Work accident24
Domestic accident24
Fall from height24
Unknown12

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.

References (12)

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    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.

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    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

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    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 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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