Blunt Trauma: Sternal and Rib Fracture
Brief: Sternal and rib fractures are bone injuries
in the chest area. A sternal fracture is a break
in the breastbone (sternum), often caused by
chest trauma, leading to pain and difficulty
breathing. Rib fractures are cracks or gaps in
the rib bones, commonly resulting from trauma
or underlying conditions like osteoporosis,
causing sharp chest pain, especially during
breathing or movement.
Definition:
Sternal Fracture:a bone injury involving a break or
cracks in the sternum, which is the central bone in
the chest. It is typically caused by trauma or a
direct blow to the chest.
Rib Fracture: a bone injury characterized by a
break or crack in one or more of the ribs. It can
result from various factors, including trauma, falls,
or underlying medical conditions like osteoporosis.
Risk Factors for Sternal Fractures:
1. Trauma from high-impact accidents.
2. Older age due to age-related changes in
bone density.
3. Osteoporosis, weakening the sternum.
4. Participation in contact sports or
activities with chest injury risk.
Risk Factors for Rib Fractures:
1. Trauma to the chest from various
causes.
2. Osteoporosis, leading to brittle ribs.
3. Advanced age with reduced bone
density.
4. Specific medical conditions weakening
bones.
5. Long-term use of corticosteroid
medications.
6. Smoking, which lowers bone density.
Clinical Management:
1. Assessment: Evaluate the severity and
associated injuries through physical
examination and imaging.
2. Pain Management: Administer pain
relief medications, both over-the-counter
and prescription, to alleviate discomfort.
3. Respiratory Support: Encourage deep
breathing exercises to maintain lung
function and prevent complications.
4. Immobilization and Support: Use rib
belts, wraps, or braces to limit chest
movement, reducing pain during
breathing and movement.
5. Follow-up and Monitoring: Schedule
regular appointments to track healing
progress and ensure no complications
arise.
6. Surgical Intervention: Consider
surgery in severe or complicated cases,
involving rib stabilization or sternal
repair.
7. Complications Management: Promptly
address and manage any complications,
such as pneumonia or pneumothorax.
8. Rehabilitation: After initial healing,
engage in rehabilitation and physical
therapy to restore chest mobility and
strength.
Pathophysiology:
Sternal Fracture Clinical Manifestations:
1. Chest Pain: The most common
symptom is sharp or aching pain in the
chest, especially at the site of the
fracture.
2. Tenderness: The sternum area is
tender to the touch.
3. Swelling: Swelling and bruising may
occur over the sternum.
 4. Painful Breathing: Pain intensifies with
deep breaths, coughing, or movements.
5. Difficulty Breathing: Severe fractures
can lead to difficulty in taking deep
breaths, which can result in shallow
breathing.
6. Crepitus: In some cases, a grating
sensation or sound (crepitus) may be
felt or heard when touching the fractured
area.
7. Bruising: Ecchymosis (bruising) may
develop around the chest.
Rib Fracture Clinical Manifestations:
1. Localized Pain: Pain is usually sharp
and localized to the area of the fractured
rib(s).
2. Pain During Breathing: Breathing
deeply, coughing, or sneezing worsens
the pain.
3. Tenderness: The affected rib(s) are
tender to the touch.
4. Chest Wall Deformity: In severe cases
or with multiple fractures, a noticeable
deformity or chest wall asymmetry may
be present.
5. Shallow Breathing: Patients may
develop shallow breathing patterns to
minimize pain.
6. Creptius: Similar to sternal fractures,
crepitus (a grating sensation or sound)
may be felt or heard when touching the
fractured rib(s).
7. Muscle Spasm: Muscles around the
injured area may go into spasm,
contributing to pain and restriction of
movement.
Medical/ Pharmacological Management:
Pain Management:
 Over-the-counter pain relievers like
acetaminophen or nonsteroidal anti-
inflammatory drugs (NSAIDs).
 Prescription opioids for severe pain.
 Regional anesthesia techniques, such
as nerve blocks, for targeted pain relief.
Respiratory Support:
 Encourage deep breathing exercises
and incentive spirometry to maintain
lung function and prevent complications
like pneumonia.
 Monitor oxygen saturation levels and
provide supplemental oxygen if
necessary.
Complications Prevention and
Management:
 Administer medications or treatments to
prevent or manage complications, such
as antibiotics for infection or chest
physiotherapy for lung clearance.
 Surgical interventions may be
considered to address specific
complications or severe fractures.
Nutrition and Hydration:
 Ensure patients receive adequate
nutrition and hydration to support
healing and overall health.
Rehabilitation:
 Collaborate with physical therapists to
develop and implement rehabilitation
exercises and activities aimed at
restoring chest mobility and strength.
Follow-up and Monitoring:
 Schedule regular follow-up
appointments to assess the healing
progress, monitor for complications, and
adjust the treatment plan as necessary.
Nursing Considerations:
1. Thorough assessment of the
fracture, vital signs, and pain
level.
2. Pain management through
medications and relaxation
techniques.
3. Promoting deep breathing
exercises and lung health.
4. Assisting with safe positioning
and mobility.
5. Educating on support devices
like rib belts and braces.
6. Providing emotional support
and communication.
7. Administering medications and
monitoring nutrition.
8. Patient education and
discharge planning.
9. Vigilant monitoring for
complications.
10. Coordinating rehabilitation as
needed.
11. Accurate documentation of
care and patient responses.