title: Fractures of the sternum: the influence of non-invasive cardiac monitoring on management.
abstract: Management of sternal fractures often involves a protracted hospital stay. This is often based on serial electrocardiography (ECG) and cardiac enzyme measurement (AST, CK, LDH). This retrospective study examined all cases of sternal fracture presenting to our institution between October 1998 and February 2003. Seventy-two cases were identified, 52 of which had isolated sternal fractures. Of these, 11 (21%) patients had an elevation in all cardiac enzymes. Twenty-three (44%) had an increase in some but not all. A single patient with ECG changes had no elevation in cardiac enzymes. Those patients with elevated cardiac enzymes had a significantly longer stay of 5.5 days compared with 3.7 days (P < 0.05). No adverse outcome was recorded in either group. We conclude that ECG and estimation of cardiac enzymes in these patients are of limited benefit and, when abnormal, appear to be associated with a significantly protracted and probably unnecessary hospitalisation.
authors.affiliation: Department of General Surgery, Our Lady's Hospital, Navan, Co. Meath, Republic of Ireland.
authors.forename: T B
authors.initials: TB
authors.lastname: Wedde
authors.forename: J F
authors.initials: JF
authors.lastname: Quinlan
authors.forename: A
authors.initials: A
authors.lastname: Khan
authors.forename: H J
authors.initials: HJ
authors.lastname: Khan
authors.forename: F O
authors.initials: FO
authors.lastname: Cunningham
authors.forename: J P
authors.initials: JP
authors.lastname: McGrath
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001219:Aspartate Aminotransferases / Q000097:blood; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography; D005260:Female; D050723:Fractures, Bone / Q000201:enzymology / Q000628:therapy*; D006769:Hospitals, General; D006801:Humans; D007494:Ireland; D007770:L-Lactate Dehydrogenase / Q000097:blood; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D013249:Sternum / Q000293:injuries*
chemical_list: D003404:Creatinine; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases