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Case report
Three women in a car
  1. S Satchithananda
  1. Emergency Department, Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk PE30 4ET, UK
  1. Correspondence to:
 Dr S Satchithananda; 
 sue.satchi{at}doctors.org.uk

https://doi.org/10.1136/emj.20.3.297

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    Isolated sternal fractures have been increasing in number since the advent of seat belt legislation in 1983.1 The management of these patients has been a matter of debate for some time. These cases demonstrate that other coexistent pathology may be difficult to identify at the time of presentation and that a high level of suspicion for other injuries is necessary. Three women presented to the emergency department after a collision between their car travelling at 45 miles per hour and a stationary van.

    CASE 1

    The 71 year old restrained driver of the car presented complaining of chest pain and tenderness. Previous medical history included osteoporosis and long term corticosteroid use for asthma. Initial observations, examination, chest radiograph, and electrocardiogram were normal. A sternal radiograph demonstrated a fracture of the sternum. A brief episode of hypotension was noted (systolic blood pressure of 90) but thought to be vagal and the patient was later discharged home with oral analgesia.

    CASE 2

    The 77 year old restrained front seat passenger also presented with chest pain and tenderness. Initial observations, chest radiograph and …

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