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Sternal Injuries in Sport: A Review of the Literature

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Abstract

Sternal fractures were first described in published literature in the 19th century as a complication of traumatic injury. Though sternal fracture and other sternal injuries have been described in trauma literature, there remains a paucity of literature with regards to sternal injury in sport. Sternal injury may include disruption at the body, manubrium and xiphoid process, or at associated sternoclavicular, manubriosternal, and xiphisternal joints. In the athlete it is imperative to evaluate sternal injury with consideration of potentially devastating cardiothoracic complications. Return-to-play protocols should be individualized, taking into account subjective history, objective physical examination and diagnostics, current clinical guidelines, and individual sport-specific considerations. The literature regarding sternal injury is reviewed, with emphasis on sport-specific pathology, management, and return to play.

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Reprinted with permission from Taylor et al. [17]

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Reprinted with permission from Taylor et al. [17]

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References

  1. Johnson I, Branfoot T. Sternal fracture—a modern review. Arch Emerg Med. 1993;10(1):24–8.

    Article  CAS  Google Scholar 

  2. Miller M, Thompson SR. DeLee and Drez’s orthopaedic sports medicine. 4th ed. Amsterdam: Elsevier; 2009. p. 893–900.

    Google Scholar 

  3. Gatzoulis MA, Standring S. Gray’s anatomy: the anatomical basis of clinical practice. 40th ed. Amsterdam: Elsevier; 2008. p. 917–26.

    Google Scholar 

  4. Yey DD, Hwabejire JO, Demoya MA, et al. Sternal fracture—an analysis of the National Trauma Data Bank. J Surg Res. 2014;186:39–43.

    Article  Google Scholar 

  5. Celik B, Sahin E, Nadir A, et al. Sternum fractures and effects of associated injuries. Thorac Cardiovasc Surg. 2009;57(8):468–71.

    Article  CAS  Google Scholar 

  6. Recinos G, Inaba K, Dubose J, et al. Epidemiology of sternal fractures. Am Surg. 2009;75(5):401–4.

    PubMed  Google Scholar 

  7. Brukner P, Khan K. Clinical sports medicine. 3rd ed. New York: McGraw Hill; 2007. p. 347.

    Google Scholar 

  8. Gregory P, Biswas A, Batt M. Musculoskeletal problems of the chest wall in athletes. Sports Med. 2002;32(4):235–50.

    Article  Google Scholar 

  9. Moran B, Bryan S, Farrar T, Salud C, Visser G, DeCuba R, Renelus D, Buckley T, Dressing M, Peterkin N, Coris E. Diagnostic evaluation of nontraumatic chest pain in athletes. Curr Sports Med Rep. 2017;16(2):84–9.

    Article  Google Scholar 

  10. Van Tongel A, De Wilde L. Sternoclavicular joint injuries: a literature review. Muscles Ligaments Tendons J. 2011;1(3):100–5.

    PubMed  Google Scholar 

  11. Morell D, Thyagarajan D. Sternoclavicular joint dislocation and its management: a review of the literature. World J Orthop. 2016;7(4):244–50.

    Article  Google Scholar 

  12. Hayashi D, Roemer FW, Koehler R, Guermazi A, Gebers C, De Villiers R. Thoracic injuries in professional rugby players: mechanisms of injury and imaging characteristics. Br J Sports Med. 2014;48(14):1097–101.

    Article  Google Scholar 

  13. Cruz M, Erdeljac J, Williams R, Brown M, Bolgla L. Posterior sternoclavicular joint dislocations in a division I football player: a case report. Int J Sports Phys Ther. 2015;10(5):700–11.

    PubMed  PubMed Central  Google Scholar 

  14. Groh GI, Wirth MA. Management of traumatic sternoclavicular joint injuries. J Am Acad Orthop Surg. 2011;19(1):1–7.

    Article  Google Scholar 

  15. Gilot GJ, Wirth MA, Rockwood CA Jr. Injuries to the sternoclavicular joint. Rockwood and Green’s fractures in adults. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 1365–97.

    Google Scholar 

  16. Laffosse J, Espie A, Bonnevialle N, Mansat P, Tricoire J, Bonnevialle P, Chiron P, Puget J, et al. Posterior dislocation of the sternoclavicular joint and epiphyseal disruption of the medial clavicle with posterior displacement in sports participants. J Bone Jt Surg Br. 2010;92B:103–9.

    Article  Google Scholar 

  17. Taylor R, Cronin K, Mclean N, et al. Diagnosis and treatment of posterior sternoclavicular dislocations in athletes. EC Orthop. 2016;4(3):556–8.

    Google Scholar 

  18. Robinson C, Jenkins P, Markham P, Beggs I. Disorders of the sternoclavicular joint. J Bone Jt Surg Br. 2008;90(6):685–96.

    Article  CAS  Google Scholar 

  19. Rockwood C Jr, Odor J. Spontaneous atraumatic anterior subluxation of the sternoclavicular joint. J Bone Jt Surg Am. 1989;71(9):1280–8.

    Article  Google Scholar 

  20. Jelenko C, Cowan G Jr. Perichondritis (Tietze’s syndrome) at the xiphisternal joint: a mimic of severe disease. JACEP. 1977;6(12):536–42.

    Article  Google Scholar 

  21. Tepolt F, Carry PM, Heyn PC, et al. Posterior sternoclavicular joint injuries in the adolescent population: a meta-analysis. Am J Sports Med. 2014;42(10):2517–24.

    Article  Google Scholar 

  22. Stančák A, Němec J, Havlas V. Rare dorsal traumatic sternoclavicular joint dislocation in a 14-year-old patient—a case report. Acta Chir Orthop Traumatol Cech. 2017;84(3):215–8.

    PubMed  Google Scholar 

  23. Robertsen K, Kristensen O, Vejen L. Manubrium sterni stress fracture: an unusual complication of non-contact sport. Br J Sports Med. 1996;30:176–7.

    Article  CAS  Google Scholar 

  24. Neumann J, Kirkendall D, Claude T III. Sports medicine for the orthopedic resident. Singapore: World Scientific; 2016. p. 58.

    Book  Google Scholar 

  25. Culp B, Hurbanek J, Novak J, McCamey K, Flanigan D. Acute traumatic sternal fracture in a female collegiate hockey player. Orthopedics. 2010;33(9):683.

    Article  Google Scholar 

  26. Fowler A. Flexion-compression injury of the sternum. J Bone Jt Surg Br. 1957;39-B(3):487–97.

    Article  CAS  Google Scholar 

  27. Keating T. Stress fracture of the sternum in a wrestler. Am J Sports Med. 1987;15(1):92–3.

    Article  CAS  Google Scholar 

  28. Sanders SM, Richardson JB, Hartrich W, et al. Sternal non-union in a professional hockey player: considerations for return to play. Orthop Rev. 2009;1(1):20–1.

    Article  Google Scholar 

  29. Khoriati A, Rajakulasingam R, Shah R. Sternal fractures and their management. J Emerg Trauma Shock. 2013;6(2):113–6.

    Article  Google Scholar 

  30. Athanassiadi K, Gerazounis M, Moustardas M, Metaxas E. Sternal fractures: retrospective analysis of 100 cases. World J Surg. 2002;26(10):1243–6.

    Article  Google Scholar 

  31. Yeh G, Williams G Jr. Conservative management of sternoclavicular injuries. Orthop Clin N Am. 2000;31:189–203.

    Article  CAS  Google Scholar 

  32. Vanzo V, Bugin S, Snijders D, et al. Pneumomediastinum and pneumopericardium in an 11 year old rugby player: a case report. J Athlet Train. 2013;48(2):277–81.

    Article  Google Scholar 

  33. Lee WJ, Lin HY. Severe chest pain after blunt chest trauma. Emerg Med J. 2011;28(5):451–2.

    Article  Google Scholar 

  34. Morgenstern M, von Rüden C, Callsen H, Friederichs J, Hungerer S, Bühren V, Woltmann A, Hierholzer C. The unstable thoracic cage injury: the concomitant sternal fracture indicates a severe thoracic spine fracture. Injury. 2016;47(11):2465–72.

    Article  Google Scholar 

  35. Peek G, Firmin R. Isolated sternal fracture: an audit of 10 years’ experience. Injury. 1995;26(6):385–8.

    Article  CAS  Google Scholar 

  36. Barbaix E. Stress fracture of the sternum in a golf player. Int J Sports Med. 1996;17(4):303–4.

    Article  CAS  Google Scholar 

  37. Hassan I, Ramgole D, Van Rensburg D, Grant C, Collins R. Sternal stress fracture in a gymnast: a case report and literature review. S Afr J Sports Med. 2010;22(2):50–1.

    Article  Google Scholar 

  38. Guska S, Pilav I, Musanovic S. Clinical significance of isolated sternal fracture. Med Arthr. 2010;64(1):17–21.

    Google Scholar 

  39. McCurdie I, Etherington J, Buchanan N. Sternal fracture in a female army officer cadet. Br J Sports Med. 1997;31(2):164.

    Article  CAS  Google Scholar 

  40. Gloyer MA, Frei HC, Hotz TK, et al. Osteosynthesis of traumatic manubriosternal dislocations and sternal fractures with a 3.5/4.0 mm fixed angle plate. Trauma Surg. 2011;131:1261–6.

    Google Scholar 

  41. Sebes J, Salazar J. The manubriosternal joint in rheumatologic disease. Am J Roentgenol. 1983;140:117–21.

    Article  CAS  Google Scholar 

  42. Kalicke T, Frangen TM, Muller EJ, et al. Traumatic manubriosternal dislocation. Arch Orthop Trauma Surg. 2006;126:411–6.

    Article  Google Scholar 

  43. Smith M, Lenehan B, O’Keefe D, Martin A. Manubriosternal joint dislocation in contact sport. Emerg Med J. 2001;18(6):488–9.

    Article  CAS  Google Scholar 

  44. Lyons I, Saha S, Arulampalam T. Manubriosternal joint dislocation: an unusual risk of trampolining. J Emerg Med. 2010;39(5):596–8.

    Article  Google Scholar 

  45. Kälicke T, Frangen T, Müller E, Muhr G, Hopf F. Traumatic manubriosternal dislocation. Arch Orthop Trauma Surg. 2006;126(6):411–6.

    Article  Google Scholar 

  46. Woo C. Traumatic manubriosternal joint subluxations in two basketball players. J Manipulative Physiol Ther. 1988;11(5):433–7.

    CAS  PubMed  Google Scholar 

  47. Rist A, Willscheid G, Rasch H, Paul J. “Manubriosternal synchondrosis”: a rare problem in sports medicine. Sportverletz Sportschaden. 2016;30(4):229–31.

    Article  CAS  Google Scholar 

  48. Nijs S, Broos P. Sterno-manubrial dislocation in a 9-year old gymnast. Acta Chir Belg. 2005;105:422–4.

    Article  CAS  Google Scholar 

  49. Pidcoe P, Burnet E. Rehabilitation of an elite gymnast with a type II manubriosternal dislocation. Phys Ther. 2007;87(4):468–75.

    Article  Google Scholar 

  50. Dastgeer G, Milkolich D. Fracture-dislocation of manubriosternal joint: an unusual complication of seizures. J Trauma Acute Care Surg. 1987;27(1):91–3.

    Article  CAS  Google Scholar 

  51. Moore K, Dalley A, Agur A. Clinically oriented anatomy. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2013. p. 84.

    Google Scholar 

  52. Lipkin M, Fulton L, Wolfson E. The syndrome of the hypersensitive xiphoid. N Engl J Med. 1955;253:591–7.

    Article  CAS  Google Scholar 

  53. Hogerzeill D, Hartholt K, Rem de Vriess M. Xiphoidectomy: a surgical intervention for an underdocumented disorder. Case Rep Surg. 2016;2016:9306262.

    Google Scholar 

  54. Howell J. Xiphodynia: a report of three cases. J Emerg Med. 1992;4:435–8.

    Article  Google Scholar 

  55. Sklaroff H. Xiphodynia-another cause of atypical chest pain: six case reports. Mt Sinai J Med. 1979;46(6):546–8.

    CAS  PubMed  Google Scholar 

  56. Shilo L, Hadari R, Shabun A, Shilo D, Kitay-Cohen Y. Xiphodynia: an easily diagnosed but frequently overlooked cause of non-cardiac chest pain. J Musculoskelet Pain. 2014;22(4):378.

    Article  Google Scholar 

  57. Sano A, Inui M. Xiphoidectomy for xiphoid process-induced pain in a surfer. Asian Cardiovasc Thorac Ann. 2015;23(9):1116–8.

    Article  Google Scholar 

  58. Hanlon CR, Miller MM. Deformity of the xiphoid cartilage associated with gastrointestinal symptoms. JAMA. 1954;154(12):992–3.

    Article  CAS  Google Scholar 

  59. Boehme M, Scherbaum W, Pfeiffer E. Tietze’s syndrome—a chameleon under the thoracic abdominal pain syndromes. Klin Wochenschr. 1988;66:1142–5.

    Article  CAS  Google Scholar 

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Correspondence to Jeffrey Alent.

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Authors Jeffrey Alent, Dusty Narducci, Byron Moran, and Eric Coris declare that they have no conflict of interest.

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Alent, J., Narducci, D.M., Moran, B. et al. Sternal Injuries in Sport: A Review of the Literature. Sports Med 48, 2715–2724 (2018). https://doi.org/10.1007/s40279-018-0990-5

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