Fracture Sturnum

[Babs443]

Had a bi-lateral mastectomy in September,08 had problems when I woke up and they call in a pulmonigist.  He said I had a fracture sturnum.  Didn't have one before the operation but after 2 Cat Scan and MRI both saying I have a fracture sturnum and have difficulity taking a deep breath.  Went to a thoric surgeon and he ordered another Cat Scan in two weeks.  It has been 3 months with this problem and the surgeon suggest that he could fix it but it would take at least 6 weeks to recover.  Any idea how this happened and will surgery correct this.  Please help

[National Jewish Health]

Your experience raises 2 questions:  First, how did you sustain a sternal fracture during bilateral mastectomy surgery?  And, second, what if anything should be done about it?  My literature search found no reports of fracture of the sternum associated with bilateral mastectomy.  The most common in-hospital cause of a fractured sternum is cardiopulmonary resuscitation (CPR).  Another less common would be falling out of bed.  You should have a frank discussion with your surgeon to request his/her opinion of the most likely cause of your fracture and, specifically if manipulation of the sternum was required as a part of the surgical procedure.  If he/she has no explanation that would link the surgery to the fracture, including loss of muscle support of the sternum as part of the surgical procedure, the cause may remain a mystery.  You might also want to review your medical records with your surgeon, on the off-chance that an explanation might emerge.

The second question relates to what should be done to promote sternal fracture healing and the answer may be nothing.  For example, while sternal fractures are often seen in emergency departments of trauma centers, it is seldom recommended that they be surgically repaired.  What you should request is the expert opinion of a thoracic trauma surgeon who has had vast experience in the management of sternal fractures, ideally at an institution where such fractures are a common occurrence.  You might even want to consult with an institution such as the Mayo Clinic or one similar to it.  Whatever you decide do not rush to have surgery without the benefit of an expert second opinion.

If the recommendation proves to be that you should have surgical repair you might ask the surgeon about the advantages of a DSF plate system and a stainless-steel cable system, versus the conventional wire closure techniques.

Good luck.