Disclosures: Rajbir Chaggar, MD: No financial relationships or conflicts of interest

Case Diagnosis: 20-year-old male polytrauma patient with type 2 manubriosternal dislocation

Case Description: A 20-year-old male was hospitalized after motor vehicle collision. He was admitted to the trauma service for management of multiple fractures and injuries found on primary survey. Near discharge, he endorsed bony chest pain; plain anterior-posterior (AP) chest radiography was without new osseous pathology. He was transferred to inpatient rehabilitation, where he continued to endorse proximal sternum pain.

Setting: Acute Inpatient Rehabilitation

Assessment/Results: In rehab, sternal radiographs demonstrated type 2 manubriosternal dislocation. On initial trauma survey, AP chest radiographs and a chest computerized tomography with angiography scan (CTA) with contrast showed appropriate manubriosternal articulation, which was corroborated with final AP radiography prior to transfer. Repeat chest CT in rehab confirmed presence of dislocation, with early callus formation. The patient completed rehab and followed up with outpatient thoracic surgery for open reduction and internal fixation (ORIF) with sternal plating.

Discussion: Manubriosternal dislocation is a rare sequelae of blunt force trauma directly or indirectly to the sternum, that can be associated with thoracolumbar spine or rib fractures. This case highlights the importance of the concept of “one view is no view”, as this pathology was not detected with AP views. It has been suggested that patients with spinal injuries and sternal pain be evaluated with a dedicated lateral view, to specifically assess for manubriosternal dislocation. Cases are typically managed with closed reduction, ORIF, or monitoring for pathology and pain.

Conclusion: This case demonstrates the importance of multiple views to assess bony pathology, specifically the importance of lateral views in a patient with rib, spinal fractures and sternal pain. Further research into optimal medico-surgical management of manubriosternal dislocations may be warranted.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/when-one-view-is-no-view-type-2-manubriosternal-dislocation-a-case-report/