The sternum is a part of the human bone skeleton, located in the front of the chest and, along with the ribs, protecting its organs from mechanical influences from the outside.
A fracture of the sternum is considered one of the most dangerous types of injuries in traumatology, which is associated with the possible occurrence of severe complications.
Anatomy of the sternum
The sternum is dagger-shaped in its structure. It has the following parts: a handle, a body and a xiphoid process located in the lower part of the sternum.
At the top of the handle of the sternum there is a small notch - the jugular notch, and on the sides of it there are clavicular notches, which are the place of attachment of the sternal ends of the clavicle.
The body of the sternum on its lateral surfaces has recesses to which costal cartilages are attached (starting from the second rib). The junction of the body and the handle of the sternum protrudes slightly forward, forming the angle of the sternum.
It should be noted that this part of the bone skeleton in different people can vary in size and shape. There may be a bifurcation of the sternum or the presence of a hole in it.
Speaking of the sternum, it's impossible not toremember that in the spongy substance of which it consists, there are a large number of blood vessels, which allows for blood transfusion in this area. Also of great importance in practical medicine is the presence of a developed bone marrow in the sternum, which opens up great opportunities for its donation.
Main causes of sternum fracture
Most often, such a fracture is the result of a direct mechanical impact on the sternum. This is a strong blow to the chest against various parts of the car at the time of a car accident or the directed impact of a blunt object in the chest. In this case, combined fractures with damage to the ribs can occur, leading to various complications. Most often, costal injuries occur at the junction of the handle and the body of the sternum.
Classification
Depending on the severity of the damage, they distinguish:
- incomplete fracture (sternum fissure);
- complete fracture.
Depending on damage to the skin, the following types of fractures are distinguished:
- open fracture;
- closed sternum fracture.
Open type of fractures is the most dangerous, due to the risk of infectious agents entering the wound surface, which is associated with the development of further septic complications.
Depending on the location of bone fragments, they distinguish:
- fracture without displacement;
- displaced fracture.
FractureDisplaced sternum is characterized by a violation of the anatomical location of bone fragments, which leads to serious damage to neighboring organs (pleura, lungs, heart, diaphragm) with the development of appropriate complications.
Distinguished by localization:
- fracture of the manubrium of the sternum;
- fracture of the body of the sternum;
- Fracture of the xiphoid process.
Symptoms and Diagnosis
Signs of a fracture of the sternum are quite pathognomonic, that is, specific for this type of injury:
- Sharp pain in the sternum, aggravated by breathing and coughing.
- Breathing in fractures of the sternum becomes shallow and frequent.
- The patient takes a forced position, sitting hunched over (thus reducing pain).
- Swelling and deformity over the injury site.
- The occurrence of a hematoma.
- Palpatory determination of bone fragments in fractures with displacement.
- The lateral chest x-ray provides more complete information about the location and nature of the fracture.
It should be noted that these symptoms of a fracture of the sternum may not appear when an incomplete fracture (crack) occurs. Therefore, after a serious chest injury, it is important to see a doctor in time.
If the displacement of fragments is significant, then they may injure the lungs, pleura or organs located in the mediastinum.
Treatment of fractures without displacement
Suchthe fracture variant responds better to conservative treatment.
The first step in the treatment of such fractures is the introduction of 20 ml of a 1% solution of novocaine into the area of damage and the appointment of systemic analgesics for analgesic purposes.
Due to the development of difficulty in breathing in such cases, it is advisable to use humidified oxygen inhalations.
Next, it is obligatory to apply a wide tape of a specialized patch along the entire sternum, which will fix the chest for two weeks.
Treatment of displaced fractures
If there is still a displacement, then restoration of the integrity of the sternum is possible through manual reposition of the fragments. Of course, this action is carried out after effective anesthesia. After repositioning, the patient should lie on a bed with a shield for three weeks. A roller is placed between the patient's shoulder blades. Thus, a prolonged hyperextension position leads to a gradual restoration of the position of bone fragments.
Unfortunately, the structure of the sternum is not always restored in this way. In some cases, doctors have to resort to surgical treatment of a sternum fracture - osteosynthesis with crossed wires or plates.
Working ability after that is restored within two months.
Consequences
Fractures of the ribs and sternum, especially with significant displacement of fragments, are often accompanied by serious conditions requiring immediate medical attentionspecialists. This is due to the fact that this part of the bone skeleton, which has a traumatic effect, is located in close proximity to vital organs - the heart and lungs. Bone fragments can damage the serous integument of these organs, violating their integrity.
The consequences of a sternum fracture include:
- hemopericardium - a condition characterized by the presence of blood in the pericardial membrane (that is, in a kind of "gap" between the two membranes of the heart - the pericardium and epicardium), which leads to the development of disorders in the myocardium;
- pneumothorax - accumulation of air in the pleural cavity covering the lung, leading to inhibition of lung activity due to compression of the organ;
- hemothorax - the presence of blood in the pleural cavity, which has a depressing effect on gas exchange in the lungs and, as a result, the respiratory function of the organ.
In case of chest injuries, it is necessary to pay attention to the emerging symptoms that accompany such pathological conditions. The best option is to see a doctor immediately.
Hemopericardium
When such a pathological condition occurs, characteristic symptoms occur:
- weakness;
- sweating;
- pain in the region of the heart of a different nature;
- feeling of pressure in the region of the heart;
- expressed shortness of breath;
- tachycardia;
- feeling fear of death;
- cyanosis of the skin;
- swelling of the veins of the face, neck and upperlimbs.
If you have these symptoms, seek immediate medical attention.
If the amount of blood in the pericardium is insignificant, then conservative treatment with bed rest and the appointment of painkillers, hemostatic and heart drugs is possible.
In case of rapid accumulation of blood in the pericardial sac, there is a high risk of developing cardiac tamponade and death in the first minutes of its occurrence. Such situations arise when 400-500 ml of blood is simultaneously in the pericardial sac. Then urgent measures are needed in the form of drainage of the pericardium or pericardiocentesis with aspiration of blood with a needle inserted into the pericardium, relieving blood pressure on the heart and restoring cardiac activity. These activities are carried out under the control of echocardiography and ECG.
In case of direct damage to the heart, a surgical operation is performed to restore the integrity of the organ and stop bleeding. Simultaneous resuscitation measures are mandatory - oxygen therapy and restoration of blood loss by transfusion of blood plasma, its components and infusion solutions.
Hemothorax
This complication is manifested by a severe general condition, a significant decrease in blood pressure, a frequent thready pulse and shortness of breath. Visually, the person is bluish-pale due to the development of respiratory failure.
The treatment of hemothorax is to puncture the pleural cavity and evacuate blood from it. At the same time, blood volume is replenished.
In case of rapid and ongoing blood loss, a major surgical operation is needed - a thoracotomy.
Pneumothorax
This complication occurs in every third person with a chest injury. Pneumothorax is manifested by increased blood pressure, slight tachycardia and shortness of breath.
It is necessary to puncture the pleural cavity in 2-3 intercostal spaces along the midclavicular line and install a drain, the free end of which is lowered into the water.
If air bubbles are released through the drainage for more than 2 days, which is a sign of damage to the large bronchus, then a thoracotomy is also necessary.
