Acute Traumatic Sternum Fracture in a Female College Hockey Player

Trauma literature contains documentation of sternal fractures, and the management principles continue to evolve.^1--4 However, little has been reported about sternal fractures in athletes. The sports literature is limited to case reports of sternal stress fractures in sports such as baseball, diving, golf, gymnastics, weight lifting, and wrestling,^5--10 as well as 1 report of a nondisplaced sternal fracture of a rugby player.¹¹

The pathomechanics of sternal fractures in an athlete differ significantly from the classic steering wheel syndrome and the more recently described safety-belt syndrome. The large forces associated with a motor vehicle accident can cause a number of injuries presenting as chest pain, including pathology of the heart, lungs, vasculature, and bones.¹² These are rarely associated with sporting injuries due to the dramatically lower forces. Other conditions in the differential of chest pain in an athlete are more likely, and include stress fractures, dislocations, soft tissue injuries, and nonmusculoskeletal-related issues.^10,13 Because the physis of the sternum or medial clavicle do not completely ossify before age 18, physeal injury must be suspected with chest pain in a young athlete. Traumatic sternal fractures often have other associated injuries, the most frequent of which are rib fractures (22% to 32% when an associated injury has occurred).^12,14 The injury pattern describing stress fractures of the sternum consistent with repetitive microtrauma has far fewer comorbidities than some of the mentioned etiologies.

To our knowledge, there has been only 1 previous report of a sports-related, isolated sternal fracture, which occurred in a rugby match.¹¹ That player's injury was missed on routine radiographs, but was eventually diagnosed by bone scan. Upper body training and activity was restricted for 6 weeks, and the rugby player made a full recovery.

This article describes a rare fracture to the distal one-third of the sternum sustained by a female hockey player after a checking collision.

Case Report

An 18-year-old female college hockey player sustained a chest-to-chest check from another player during a game. She was able to skate off the ice but reported immediate chest pain. The patient was transported to the local emergency department. Her history revealed no pertinent medical issues. She was found to be medically stable, with negative radiographs and a normal electrocardiogram (EKG), and...