Common Truck Wreck Injuries: Sternal Fractures

Following an accident with a semi-truck or other commercial motor vehicle, such as flatbed trucks or dump trucks, those involved could sustain a variety of injuries. Some of these injuries can be rather serious or catastrophic due to the nature of the accident. One more serious injury that can occur is a sternal fracture.

While sternal fractures are a fairly uncommon chest wall injury, they typically result from a direct blow to the chest, which can be caused by an acceleration-deceleration injury. The sternum or breastbone is one of the stronger bones in the body, and in fit and healthy individuals, a significant injury to the sternum can suggest a severe blow. But for individuals that are more frail, such as those with osteopenia or weak bones, even a minor blow can cause a fracture.

Most sternal fractures can resolve on their own, but depending on the severity, a fracture can lead to many complications in the surrounding organs in the chest region.

How a Wreck Can Cause Sternal Fractures

A sternal fracture primarily results from blunt, anterior chest wall trauma and deceleration injuries. The primary cause of sternal fractures is motor vehicle collisions, with 68% of these injuries caused by accidents. Sternal fractures occur in 3% to 6.8% of motor vehicle collisions.

The other most common causes of sternal fractures are falls at 7.9%, motorcycle accidents at 7.9%, pedestrian versus motor vehicles at 3.4%, and cycling accidents at 1.4%. Overall, sternal fractures are most often caused by some form of motor vehicle collision.

Seat belt legislation that mandates shoulder restraints has contributed to an increase in the incidence of sternal fractures, due to the placement of the belt and the force of a collision. These fractures can also be a result of the chest striking the steering wheel in a wreck, with the injury occurring most often in older vehicles that lack airbag deployment. Whether or not the seatbelt or steering wheel causes a direct or indirect blow depends on the force of the collision, but in accidents involving semi-trucks and other large commercial motor vehicles, the force of the impact is increased and can lead to more severe fractures.

Symptoms of Sternal Fracture

While some injuries may not be apparent immediately after an accident with either a passenger vehicle or semi-truck, those with sternal fractures typically experience symptoms when the injury happens. However, those symptoms may calm down over time. Regardless, it is important to seek medical attention immediately after a wreck to ensure injuries are not severe.

Most people with sternal fractures will experience a sudden onset of chest pain at the time of the injury. This pain is often sharp and intense, and that pain can increase while breathing deeply, coughing, laughing, or sneezing. Shortness of breath is a result of chest wall pain not allowing deep breaths.

In the first few days after the injury, it is common to experience an ache in the front of the chest that is most prominent first thing in the morning or at night. The pain may also increase when lying down in specific positions, such as on your side or face down. Firmly touching the sternum at the site of the injury can also cause an increase in pain. Bruising and swelling may also present in the days following the initial injury.

If the fracture is severe with bony displacement, the injury can appear as an obvious deformity. Those with severe fractures may experience more pain with typical movements than someone with a simple fracture. These movements can include shifting of the upper back and chest — like bending forward or sideways, arching backwards, or general twisting — and moving the upper limbs — such as heavy lifting, pushing, pulling, or overhead activities.

Sternal Fracture Severity

Sternal fractures are typically categorized as simple or complex.

A single fracture that is partially or completely through the sternum is considered simple. It is not usually displaced or angulated. This fracture is accompanied by pain, tenderness, and bruising.

A complex fracture typically involves single or multiple fractures where the bone is displaced, meaning the broken ends of the bone are misaligned or overlapping. This creates a step, or lump, on the front of the chest. The more complex the fracture, the more likely it is to cause complications.

One of the most common complications with sternal fractures is long-term pain. While it is typical for pain to be immediate and severe around the fracture, as well as sore to the touch and worse with certain movements, the pain will eventually settle for most people.

For others, however, the pain can persist and become chronic, causing significant issues. This is often caused by lack of proper management of the initial injury, which requires painkillers, rest, restrictions of activity, and returning to normal activities slowly if a doctor advises. Failure to do so can prevent pain resolution. This chronic pain can also lead to ongoing breathlessness.

Consistent pain can also be a result of xiphisterna injury. This injury normally presents as pain at the bottom of the sternum in the solar plexus. It can occur even after a minor injury, typically to the xiphisterna junction or the xiphisternum itself. This area is made of cartilage, making it more susceptible to injury and inflammation, which can cause long-term pain and discomfort.

When the sternal fracture is severe or complex, it can also cause chest deformity. If the sternum is badly displaced, a lump may form over the fracture site. While the fracture can heal even when it is displaced, patients may be left with a permanent lump with tenderness.

Breathlessness can also be associated with lung collapse after injury, the development of a chest infection like pneumonia, or a build up of fluid in the chest cavity. If the fracture is severe, blood can build up around the lungs and heart. Retained fluid can trap the lungs and cause collapse. The heart itself may also be bruised, contributing to breathlessness.

Steps Taken to Diagnose Sternal Fractures

Majority of patients with sternal fractures that go to the emergency room require close monitoring, sometimes in an intensive care unit. Evaluation and management of sternal fractures begins with assessment of airways, breathing, and circulation, followed by a survey to address any life-threatening conditions if the fracture is complex. Any associated injuries need to be managed promptly.

A doctor will speak with the patient and take a history of the injury, as well as perform a careful physical examination of the chest. It is best to have this exam done by a doctor that is familiar with chest wall injuries. This exam could reveal swelling, tenderness, crepitus or a crunchy feeling underneath the skin, or a step if the fracture is complex.

Following the exam, the doctor may order the following tests:

• X-ray: The most useful type of x-ray for looking at a sternal fracture is called a lateral sternal view. And while this test may not be the most effective because an x-ray can be insensitive to picking up sternal injuries, it can help identify associated issues, such as fluid in the chest or a collapsed lung.
• Chest wall ultrasound: This test may show the sternal fracture and any associated internal bruising, or other internal issues like fluid around the heart.
• Chest CT scan: The scan is best for clearly showing the severity of the sternal fracture and display other chest injuries, such as bruising behind the breastbone, lung bruising or contusions, and fluid around the heart. The widespread adoption of CT scans in cases of trauma assessment has led to increased detection of minor sternal fractures, as well.

Once the doctor has identified if the sternal fracture is simple or complex, as well as any related complications that need to be addressed, they can move forward with a treatment plan.

Treatments for Sternal Fractures

While sternal fractures pose several risks, proper management and care can lead to favorable patient outcomes. Most people recover within four to six weeks, but some may experience chronic pain.

Sternal injuries are typically treated conservatively, focusing on rest, restriction of activities, and painkillers. If necessary, a doctor may recommend physical therapy or surgical options.

Surgery is most often performed in cases of unstable fractures, thoracic wall instability, fracture displacement or persistent dislocation, severe deformity, respiratory insufficiency, failure for the fracture to reconnect or fracture non-union, or severe pain. There are several surgical methods, and the most commonly used methods are wiring and plating.

Wiring involves using stainless steel wire sutures to hold the fractured pieces in place. The lower profile of the wires makes this method less likely to cause patient discomfort and skin-related complications, making this the first choice for surgical treatment. Surgical plating can provide more stability and help restore more anterior chest wall function than wiring, and results in improved bone healing by decreasing complications and non-union.

Have You Sustained a Chest Injury from a Truck Wreck? Craig, Kelley & Faultless Can Help

Attorneys at Craig, Kelley & Faultless are prepared and have the experience to help victims and their loved ones involved in commercial vehicle wrecks through every aspect of their case. Both attorneys David W. Craig and Scott A. Faultless are board-certified in truck accident law by the NBTA, accredited by the American Bar Association. The firm also has a rapid response team—including investigators, reconstructionists and mechanics—that is sent to the scene of a wreck to collect evidence as soon as the firm is hired.

Their team-centered approach puts client needs at the forefront, and several attorneys will work on your case to achieve the best possible outcome.

Reach out for a free case consultation today at (800) 746-0226 or online.

 

David W. Craig is board-certified by the National Board of Trial Advocacy, accredited by the American Bar Association in Truck Accident Law. He sits on the Board of Regents of the Academy of Truck Accident Attorneys (which requires the board certification in truck accident law). He is the managing partner and one of the founding partners of Craig, Kelley & Faultless LLC. He is recognized as a Top 10 Trucking Trial Lawyer and Top 100 Trial Lawyer in Indiana by the National Trial Lawyers, as well as a Top 50 Indiana lawyer by Super Lawyers. David is the author of Semitruck Wreck, A Guide for Victims and Their Families and It’s Never Been Easier to Hire the Wrong Attorney, both written to help people navigate what comes next after a tragic wreck. He also hosts the podcast After the Crash, where you can gain valuable information about the dangers involving semis and large trucks that do not follow safety protocol regarding speed, weather conditions, maintenance upkeep, etc.