Clinical Case 065: Sternum vs. seatbelt

Another great US case today.

I saw this patient who had been in a rollover MVA a few days ago and had a full survey in ED, no serious injuries found and was therefore discharged in the AM.  However, she represented with ongoing chest pain which was interfering with her usual tidal breathing.  She described a painful click on using her pects!

She had her XRays with her – no fractures to see on the plain films.  She though she was just being a “bit soft” but wanted some pain relief – hence the representation.  When I asked her to point to the pain – she pointed right to the middle of her sternum.  She was very tender over that one point to palpate.

So out comes he US machine….

1. shows a fracture o the mid-sternum with associated haematoma. 2. Also shows the normal serno-manubrial joint which can be mistaken for a fracture.


So, is US any better than CXR for these painful injuries?

You bet – one small series by You et al showed US was 100% sensitive compared with ~ 70% for plain films.

Chris Nickson (LITFL) reminded me of this article – written by himself and Dr Rippey of US Village.  It is all you need to know about sternal US!

It is possible the easiest scan to do:

– palpate the sore spot

– apply the linear, high frequency probe to the sternum

– look for a crack in the cortex

– check it is not the manubrial joint, but this is usually palpable and not tender with rounded edges.

You can do this – it is easy.  Have a go.  , Casey


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