The sternum is a part of the human skeleton located in the front of the chest and along with the ribs protecting its organs from external mechanical influences.
In stomatology, sternum fracture is considered one of the most dangerous types of injuries, which is associated with the possible occurrence of serious complications.
Sternum anatomy
The sternum is dagger-like in structure. It has the following parts: handle, body and xiphoid process located in the lower part of the sternum.
On top of the sternum handle there is a small indentation - the jugular notch, and on the sides of it there are clavicular notches, which are the attachment point of the sternal ends of the clavicle.
The sternum body on its lateral surfaces has recesses to which costal cartilages are attached (starting from the second rib). The junction of the body and the sternum arm protrudes slightly, 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. Perhaps a sternum bifurcation or the presence of a hole in it.
Speaking of the sternum, it is impossible not to recall 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. The presence of a developed bone marrow in the sternum is also of great importance in practical medicine, which opens up great opportunities for its donation.
The main causes of sternal fracture
Most often, such a fracture is a result of direct mechanical effects on the sternum. This is a strong blow of the chest against various parts of the car at the time of a car accident or a directed impact of a blunt object into the chest. In this case, combined fractures with damage to the ribs can occur, leading to various kinds of complications. Most often, rib injuries occur at the junction of the handle and body of the sternum.
Classification
Depending on the severity of the damage, distinguish:
- incomplete fracture (sternum crack);
- complete fracture.
Depending on the damage to the skin, the following types of fractures are distinguished:
- open fracture;
- closed fracture of the sternum.
An open type of fracture is the most dangerous, due to the risk of infectious pathogens entering the wound surface, which is associated with the development of further septic complications.
Depending on the location of bone fragments, there are:
- fracture without displacement;
- fracture with displacement.
A sternal fracture with a shift is characterized by a violation of the anatomical location of the bone fragments, which leads to serious damage to neighboring organs (pleura, lungs, heart, diaphragm) with the development of corresponding complications.
Localization distinguishes:
- fracture of the sternum handle;
- sternum fracture;
- xiphoid process fracture.
Symptoms and Diagnosis
Signs of a sternal fracture are quite pathognomonic, that is, specific to this type of injury:
- Acute pain in the sternum, aggravated by breathing and coughing.
- Respiration during sternal fractures becomes superficial and frequent.
- The patient takes a forced position, sitting hunched over (thereby reducing pain).
- Swelling and deformation above the site of damage.
- The occurrence of a hematoma.
- Palpation determination of bone fragments in fractures with displacement.
- A chest x-ray in lateral projection provides more complete information about the location and nature of the fracture.
It should be noted that these symptoms of a sternal fracture may not occur if an incomplete fracture (crack) occurs. Therefore, after a serious chest injury, it is important to consult a doctor on time.
If the displacement of the fragments is significant, then it is possible to injure them of the lungs, pleura or organs located in the mediastinum.
Non-biased fracture treatment
This fracture option lends itself better to conservative treatment.
The first stage of the treatment of such fractures is the introduction of 20 ml of a 1% solution of novocaine into the lesion area and the appointment of a systemic analgesic for analgesic purposes.
In connection with the development of breathing difficulties in such cases, it is advisable to use inhalations with moistened oxygen.
Further, it is necessary to impose along the entire sternum a wide ribbon of a specialized patch that will fix the chest for two weeks.
Displacement Fracture Treatment
If displacement is still present, then restoration of the sternum integrity is possible through manual reduction of fragments. Of course, this action is carried out after effective analgesia. After reposition, the patient should lie on a bed with a shield for three weeks. A roller is placed between the shoulder blades of the patient. Thus, a prolonged re-extensibility 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 sternal fracture - osteosynthesis with cross-needles or plates.
Disability after this is restored within two months.
Effects
Fractures of the ribs and sternum, especially with a significant displacement of the fragments, are often accompanied by severe conditions requiring immediate medical attention by specialists. 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 sternal 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 shells of the heart - the pericardium and the epicardium), which leads to the development of disorders in the myocardium;
- pneumothorax - the accumulation of air in the pleural cavity covering the lung, leading to inhibition of pulmonary activity due to compression of the organ;
- hemothorax - the presence in the pleural cavity of the blood, 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;
- a feeling of compression in the region of the heart;
- severe shortness of breath;
- tachycardia;
- a sense of fear of death;
- cyanosis of the skin;
- swelling of the veins of the face, neck and upper limbs.
In the presence of such symptoms, emergency medical attention is needed.
If the amount of blood in the pericardium is insignificant, then conservative treatment with bed rest and the appointment of painkillers, hemostatic and cardiac drugs is possible.
In the case of rapid accumulation of blood in the pericardial sac, the risk of developing cardiac tamponade and death in the first minutes of its occurrence is high. Such situations arise when 400-500 ml of blood is in a pericardial bag at one time. Then emergency measures are needed in the form of pericardial drainage or pericardiocentesis with blood aspiration using a needle inserted into the pericardium, relieving blood pressure on the heart and restoring cardiac activity. These measures are carried out under the supervision of echocardiography and ECG.
In case of direct damage to the heart, a surgical operation is performed aimed at restoring the integrity of the organ and stopping the bleeding. Be sure to simultaneously carry out resuscitation measures - 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 filiform pulse and shortness of breath. Visually, the person is cyanotic-pale due to the development of respiratory failure.
Treatment of hemothorax consists in puncture of the pleural cavity and evacuation of blood from it. At the same time, blood volume is replenished.
In the case of rapid and ongoing blood loss, a major surgical operation is needed - thoracotomy.
Pneumothorax
This complication occurs in every third person with a chest injury. Pneumothorax is manifested by an increase in blood pressure, slight tachycardia and shortness of breath.
Puncture of the pleural cavity is necessary in 2-3 intercostal spaces along the midclavicular line and the installation of drainage, the free end of which is lowered into the water.
If air bubbles through the drainage are released for more than 2 days, which is a sign of damage to the large bronchus, then thoracotomy is also necessary.