Teaching Case

Fall from a height

63-year-old male patient involved in a fall from a 7-m height. Palpation of a sternal stairstep justified realization of a lateral chest X-ray, which was exceptionnally obtained in this trauma patient.

Sternal fractures are most often tranverse. Seventy percent of them hit the sternal body, whereas 18% involve the manubrio-sternal joint. When concomitant with rib fractures or costo-chondral dislocations, sternal fractures may be part of an anterior or lateral flail chest. Plain films remain silent in 84% of patients with sternal fracture (Fig. 2.13). In 16% of cases, sternal fractures are prone to injure the internal mammary vessels or their branches, leading to retrosternal hematomas.The lateral chest radiograph is a useful diagnostic test for sternal fractures, but is no longer obtained in blunt chest trauma patients since, in many institutions, CT has become the diagnostic survey modality of choice for chest trauma patients. CT advantageously demonstrates most fracture lines, even when transverse, sternal displacements, retrosternal hematomas and internal thoracic vessel injuries.