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LETTER TO EDITOR
Year : 2019  |  Volume : 19  |  Issue : 1  |  Page : 28-29

Sternum fracture: An uncommon sports injury


Department of Orthopaedics, Government Medical College, Haldwani, Uttarakhand, India

Date of Submission03-Mar-2018
Date of Acceptance16-Apr-2020
Date of Web Publication16-May-2020

Correspondence Address:
Ganesh Singh Dharmshaktu
M.S. (Orthopaedics), Assistant Professor, Department of orthopaedics, Government Medical Colleg, Haldwani, Uttarakhand
India
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DOI: 10.4103/sjsm.sjsm_7_18

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How to cite this article:
Dharmshaktu GS. Sternum fracture: An uncommon sports injury. Saudi J Sports Med 2019;19:28-9

How to cite this URL:
Dharmshaktu GS. Sternum fracture: An uncommon sports injury. Saudi J Sports Med [serial online] 2019 [cited 2020 Nov 28];19:28-9. Available from: https://www.sjosm.org/text.asp?2019/19/1/28/284309



Sir,

Fracture of the sternum bone is a rare event and usually results from accidental direct trauma.[1] The sports-related direct trauma constitutes a small proportion of cases, and some of them are reported as insufficiency fractures in athletes.[2],[3] These may go unnoticed or neglected as it is not readily visible on routine chest radiograph. Lateral or oblique view of the chest in suspected cases is required to diagnose it as in our case. An isolated transverse sternal fracture with a butterfly fragment has been reported here as a rare sports injury during football collision.

A 28-year-old male football player was brought to us following an inadvertent hit on the anterior chest area by the head of another player during the game. There was instant pain, but the player played through the game till completion when he complained of increased severity of pain and localized tenderness on touch to the anterior chest area. Suspecting the possibility of rib injury, he was rushed to a nearby hospital and was provided pain medications after chest radiograph showed no rib fracture in the area. There was a history of no other symptoms suggesting injuries to other sites. As the pain over the following days increased and was disabling, he was then advised lateral radiograph of the chest by us after clinical evaluation of the site of the injury. The radiograph revealed an undisplaced fracture of the sternal body below the manubriosternal joint [Figure 1]. As the injury was transverse, undisplaced, and possibly unicortical, a chest taping and strapping was done by physiotherapy unit and symptomatic treatment was given. As the fracture was visible in radiographs, no further imaging procedure was required in our case. The patient was clinically improved over the course of 3 months as the follow-up radiograph showed an uneventful union of the fracture. The case represents a rare event and injury at a rare location with uneventful recovery owing to the characteristics of fracture. Only a few cases have been reported with acute sports-related sternal fractures. Only a few cases have been reported with acute sports-related sternal fractures. The associated injuries should be ruled out in the event of sternal fracture such as chest, rib, and myocardial injuries. Patients with incomplete fractures with normal electrocardiogram or no myocardial injuries may be managed conservatively.[4] These fractures in isolation have a good prognosis, with very few experiencing protracted pain over weeks. One case of rugby player diagnosed with bone scan was reported from Australia and other in a female hockey player.[5],[6] Missed cases or those with underlying chest or heart injuries may require further management, and exclusion of concomitant injuries requires keen observation.
Figure 1: The lateral radiograph of the chest showing an undisplaced, unicortical chip fracture of the sternal body below the manubriosternal joint (arrow)

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The case highlights recognition and anticipation of rare injury to the sternal region in cases of well-defined history and location of tenderness. Judicious evaluation of radiography, with special views, if required, is crucial to diagnose the fracture.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Brookes JG, Dunn RJ, Rogers IR. Sternal fractures: A retrospective analysis of 272 cases. J Trauma 1993;35:46-54.  Back to cited text no. 1
    
2.
Knobloch K, Wagner S, Haasper C, Probst C, Krettek C, Otte D, et al. Sternal fractures occur most often in old cars to seat-belted drivers without any airbag often with concomitant spinal injuries: Clinical findings and technical collision variables among 42,055 crash victims. Ann Thorac Surg 2006;82:444-50.  Back to cited text no. 2
    
3.
Robertsen K, Kristensen O, Vejen L. Manubrium sterni stress fracture: An unusual complication of non-contact sport. Br J Sports Med 1996;30:176-7.  Back to cited text no. 3
    
4.
Gouldman JW, Miller RS. Sternal fracture: A benign entity? Am Surg 1997;63:17-9.  Back to cited text no. 4
    
5.
Douglas RJ. Sternal fracture in an Australian rules footballer. Med J Aust 2008;188:493-4.  Back to cited text no. 5
    
6.
Culp B, Hurbanek JG, Novak J, McCamey KL, Flanigan DC. Acute traumatic sterna fracture in a female college hockey player. Orthopaedics 2010;33:683-5.  Back to cited text no. 6
    


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