Disclosures: Zuhair Khan, DO: No financial relationships or conflicts of interest

Case Diagnosis: Sternal fracture due to cruciform brace

Case Description or Program Description: An 80-year-old female with a history of osteoporosis who initially presented with mid back pain with occasional radiation. Her pain had been progressing for several months, starting after a fall which resulted in several nondisplaced rib fractures. Her exam was significant for thoracic kyphoscoliosis, without neurologic deficits or tenderness on thoracic spine exam. MRI revealed an osteoporotic, subacute, severe anterior T7 compression fracture. The patient was prescribed a cruciform anterior spinal hyperextension (CASH) orthosis to reduce pain and restrict spinal mobility. Several months later at follow-up, she endorsed chest wall pain after a fall, and reported that the brace felt uncomfortable due to direct pressure over her chest wall. MRI revealed a nondisplaced and mildly angulated fracture of the sternal body and manubrium.

Setting: Outpatient clinic

Assessment/Results: The patient’s sternal/manubrial fracture likely resulted from direct pressure on the sternum by her CASH brace in addition to the blunt forces from her fall. She was fitted for a different TLSO brace which did not have direct pressure on her chest wall, and her pain significantly improved.

Discussion (relevance): Spinal orthoses are indicated for vertebral compression fractures to restrict motion to allow for healing. Specifically, CASH and Jewett hyperextension bracing is considered standard of care for compression deformities between T6 and L1. Sternal fractures typically come from high velocity forces that would be rare from a fall alone; the CASH brace’s extra point of contact increased her fracture risk. As such, CASH orthoses may not be the ideal option in those with a high fall risk. There are no other reported cases of sternal fracture related to CASH orthoses.

Conclusions: In patients prescribed CASH orthoses, providers must be cognizant of the risk of sternal fractures in patients with osteoporosis, and consider other potential bracing options if necessary.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/unusual-complication-of-a-cruciform-anterior-spinal-hyperextension-orthosis/