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There have been few reports of isolated fracture of the sternum in children. It is widely believed that such fractures are caused by a powerful blow to the chest, with a high likelihood of intrathoracic injury, such as may occur in a car crash. Experience at the children’s hospital in Edinburgh, however, suggests that sternal fracture may be a result of less dramatic trauma (
Children with possible sternal injury, including all children who had plain radiography of the sternum and all who had CT of the chest after trauma, were identified from the hospital’s radiology database for July 1998 to October 2001. There were 33 children in all, 12 of whom had sternal fracture on plain films. These twelve were 8 girls and 4 boys aged 5 to 12 years. Seven children had had a direct blow to the anterior chest wall, 4 on falling from a bicycle, and the other three after falling in the street, in the bath, and from a trampoline. Five children had sternal fractures caused by hyperflexion of the thoracic spine after falling on their backs. Three of these fell while bouncing (two on a trampoline, one on a bouncy castle) and two fell from five or six feet (one from a tree, one from a gymnasium bar). None of the children had been involved in a car crash.
Eleven children had an undisplaced fracture of the anterior cortex of the first or second sternebra of the body of the sternum. One girl had a displaced fracture through the manubriosternal joint after falling at high speed from a bicycle onto a wall. Her fracture reduced spontaneously but redisolocated after 4 days and needed internal fixation. No child had serious spinal or intrathoracic injury and all children with isolated anterior cortical fracture were discharged from the emergency department and came to no harm, though they often needed analgesia for pain on deep inspiration for several weeks.
Children may have sternal fractures after relatively minor trauma. Rib fractures, common in adults with sternal injuries, did not occur in these children. The sternum may be fractured after either a direct blow to the anterior chest wall or a fall on the upper back causing flexion-compression injury.