GÃY XƯƠNG ỨC BS Lê Văn Tài Trung Tâm Ykhoa MEDIC • A sternal fracture is a very common injury that occurs after motor vehicle collisions, particularly in restrained front seat occupants • Sternal fractures are seen in 8% to 10% of patients with blunt trauma to the chest • The most common cause of a sternal fracture is the direct impact on the sternum from the steering column or seat belt on sudden deceleration • Indirect mechanisms resulting in a sternal fracture or dislocation include a blow to the upper thoracic or cervical segment of the spine, with transmission of the force through the upper ribs or clavicle to the sternum, and stress fractures or collapse of the sternum • Sternal fractures can usually be identified with standard lateral radiography • However, this technique is not adequate in the emergency department because the exact positioning of severely injured patients for radiography is difficult Therefore, diagnosis of sternal fractures is often delayed • 5- to 10-MHz linear array transducer The transducer was placed in the maximum tenderness area with the patient in a supine position, and both longitudinal and transverse images were taken • The criteria for a sternal fracture on sonography were discontinuity and a bony defect in the sternal cortical margin with or without soft tissue hemorrhage or swelling A, Illustration of A the normal sternum, including the manubrium, sternal body, and xiphoid process On this illustration, longitudinal and transverse scanning lines are represented (A–E) B, Normal contour and no bony defect in the manubrium (MANU), sternal body, and xiphoid process (XI) on longitudinal sonography at the A-line Two gaps (arrows) are shown in the manubriosternal junction (M-S JUNCT) and sternoxiphoid junction (ST-XIPH JUNCT) C, Normal transverse contours of the manubrium on B-line scanning (B), the sternal body on C-line scanning between the third and fourth sternocostal junctions (C) and on D-line scanning of the fourth sternocostal junction (D), and the xiphoid processon E-line scanning (E) A B Figure Fracture in the upper third of the sternal body in a 39-year-old man A, Focal cortical discontinuity (arrow) is shown on longitudinal sonography of the mid sternal body B, Double anterior cortical margins (arrows) are shown on transverse sonography of the sternal body Figure Fractures in the mid sternal body in a 29-year-old man A, Lateral sternal view on CR (left) shows a fracture (arrows) with displacement in the mid sternal body C, Transverse sonography shows a large amount of peristernal hemorrhage (single arrows) and a sternal fracture (double arrow) • Sonography can be more useful because it is easy in general to perform, can be performed easily on a patient who is lying down, and does not emit radiation Also, fluids (local hematoma, and pleural effusion or hemothorax) and associated rib fractures are better observed on sonography than on CR • However, Hendrich et al reported that sonography was not suitable for portraying the grade of displacement, and Engin et al reported that the grade of displacement found on sonography was lower than that found on CR because the posterior side of the sternum could not be shown well by sonography  ... difficult Therefore, diagnosis of sternal fractures is often delayed • 5- to 10-MHz linear array transducer The transducer was placed in the maximum tenderness area with the patient in a supine... sonography at the A-line Two gaps (arrows) are shown in the manubriosternal junction (M-S JUNCT) and sternoxiphoid junction (ST-XIPH JUNCT) C, Normal transverse contours of the manubrium on B-line scanning... sternal body on C-line scanning between the third and fourth sternocostal junctions (C) and on D-line scanning of the fourth sternocostal junction (D), and the xiphoid processon E-line scanning